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QI&CPD Program2014–16 triennium handbook

Disclaimer

The information set out in this publication is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is this publication exhaustive of the subject matter. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional operates.

Whilst the text is directed to health professionals possessing appropriate qualifications and skills in ascertaining and discharging their professional (including legal) duties, it is not to be regarded as clinical advice and, in particular, is no substitute for a full examination and consideration of medical history in reaching a diagnosis and treatment based on accepted clinical practices.

Accordingly The Royal Australian College of General Practitioners and its employees and agents shall have no liability (including without limitation liability by reason of negligence) to any users of the information contained in this publication for any loss or damage (consequential or otherwise), cost or expense incurred or arising by reason of any person using or relying on the information contained in this publication and whether caused by reason of any error, negligent act, omission or misrepresentation in the information.

Published by

The Royal Australian College of General Practitioners 100 Wellington Parade East Melbourne Victoria 3002 Australia Telephone 03 8699 0414 Facsimile 03 8699 0400 Email [email protected] www.racgp.org.au

ABN 34 000 223 807 ISBN 978-0-86906-376-7 (web)

Published December 2013. Updated April 2014

© 2013 The Royal Australian College of General Practitioners. All rights reserved.

http://www.racgp.org.au/

QI&CPD Program2014–16 triennium handbook

ii QI&CPD Program2014–16 triennium handbook

Acronyms

ACCHS Aboriginal Community Controlled Health Service

AHPRA Australian Health Practitioner Regulation Agency

ALM Active Learning Module

ARC Australian Resuscitation Council

ARSP Advanced rural skills post

AQF Australian Qualifications Framework

CPD Continuing professional development

CPR Cardiopulmonary resuscitation

DRANZCOG Diploma of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists

EAR Education Activity Representative

EBMJC Evidence based medicine journal club

ENT Ear, Nose and Throat

FRACGP Fellowship of the Royal Australian College of General Practitioners

FARGP Fellowship of Advanced Rural General Practice

GP General Practitioner

GPMHSC General Practice Mental Health Standards Collaboration

HREC Human research ethics committee

NHMRC National Health and Medical Research Council

NREEC National Research and Evaluation Ethics Committee

PDSA Plan, do, study, act

PGPPP Prevocational General Practice Placement Program

QI&CPD Quality improvement and continuing professional development

RACGP Royal Australian College of General Practitioners

RPGP Rural Procedural Grants Program

RRMA Rural, Remote and Metropolitan Areas classification

RTP Regional Training Provider

STI Sexually Transmitted Infection

SCA Supervised clinical attachment

SGL Small group learning

iiiQI&CPD Program2014–16 triennium handbook

QI&CPD Program Unit contact details

Victoria

100 Wellington Parade, East Melbourne VIC 3002

Phone:(03) 8699 0483 Fax: (03) 8699 0560 Email: [email protected]

South Australia and Northern Territory

15 Gover Street, North Adelaide SA 5006

Phone: (08) 8267 8310 Fax: (08) 8267 8319 Email: [email protected]

Queensland

PO Box 1616, Coorparoo DC QLD 4151


Western Australia

PO Box 1065, West Leederville WA 6901


New South Wales and Australian Capital Territory

PO Box 534, North Sydney NSW 2060


Tasmania

206 New Town Road, New Town TAS 7008


General Practice Mental Health Standards Collaboration (GPMHSC)

100 Wellington Parade, East Melbourne VIC 300


vQI&CPD Program2014–16 triennium handbook

Contents

Acronyms ii

QI&CPD Program Unit contact details iii

Background to the QI&CPD Program 1

QI&CPD Program – triennium handbook overview 1

Enhancing patient care through quality improvement 2

QI&CPD Program participation 3

2014–16 triennium QI&CPD program requirements 3

QI&CPD Program 4

Educational principles and standards 5Systems based approach to patient safety 5

Education criteria 6

Linking the Curriculum and Domains of General Practice to the QI&CPD Program 7

Quality Assurance 11When is the Quality Assurance process initiated? 11Consequences of non-compliance 11

GP feedback on education activities 11

Clinical audit (40 Category 1 points) 13Criteria specific to the clinical audit 13Steps in the clinical audit cycle module 14Considerations 14Evidence 15

The ‘plan, do, study, act’ cycles (40 Category 1 points) 16Criteria specific to the PDSA cycles activity 16Steps in the PDSA cycle module 16Considerations 18Evidence 19

Small group learning (40 Category 1 points) 20Criteria specific to the SGL module 20Steps in the SGL cycle module 20Considerations 21Evidence 21

Evidence based medicine journal club (40 Category 1 points) 22Criteria specific to EBMJCs 23Steps in the EBMJC module 24Considerations 24Evidence 25

Supervised clinical attachment (40 Category 1 points) 26Criteria specific to the SCA module 26Steps in the SCA module 27Considerations 27Evidence 28

GP individual or group research (40 Category 1 points) 29Criteria specific to GP research groups 29

vi QI&CPD Program2014–16 triennium handbook

Criteria specific to GP research – Individual participant 29Steps in the GP group research module 29Steps in the GP individual research module 30Considerations 30Evidence 31

Active learning module (40 Category 1 points) 32Criteria specific to ALMs 32Individual ALM for GPs 32Steps in the individual ALM for GPs 32Steps in the Provider ALM 33Considerations 34Evidence 35

Educator ALM (40 Category 1 points) 36Steps in the educator ALM 36Criteria specific to the educator ALM 36Considerations 37Evidence 37

Peer review journal article module (40 Category 1 points) 38Criteria specific to peer review journal article modules 38Steps in the peer review journal article module 38Evidence 38

Higher education 39Criteria specific to higher education 39Evidence 39

Fellowship of The Royal Australian College of General Practitioners (150 Category 1 points) 40

Fellowship in Advanced Rural General Practice (150 Category 1 points) 41

Accredited Activity Provider activities (Category 2 points) 43Criteria for all Category 2 activities 43Evidence 43

Cardiopulmonary resuscitation (5 Category 2 points) 44Criteria specific to CPR 44

Self directed activities 47

Quality improvement reflection 48Criteria specific to Quality improvement reflection 48Steps in quality improvement reflection 48

Rural Procedural Grants Program 50

The practice team 50

Education providers 50

Sponsorship guidance for all activities 51

How are points allocated to GP credit point statement records? 52

GPs with specific requirements 53

QI&CPD Program development 54

Maintenance of GP records of participation 55

Privacy and patient confidentiality 55

References 56

1 QI&CPD Program2014–16 triennium handbook

Background to the QI&CPD Program

The Royal Australian College of General Practitioners (RACGP) Quality Improvement and Continuing Professional Development (QI&CPD) Program supports Australian general practitioners (GPs) to provide the best possible care for patients. The QI&CPD Program recognises ongoing education in improving the quality of everyday clinical practice by promoting the development and maintenance of general practice skills and lifelong learning.

The success of the RACGP’s internationally recognised QI&CPD Program is due to the central role of GPs in its design, development and ongoing review. Through the delivery and ongoing enhancement of its QI&CPD Program, the RACGP supports a ‘Healthy Profession. Healthy Australia’.

The RACGP QI&CPD Program for the 2014–16 triennium aims to assist Australian GPs maintain and improve the quality of care they provide to patients and promote care of the highest possible standard to the community.

The QI&CPD Program has been developed to:

• foster the value of continuous improvement within the general practice setting

• provide GPs with opportunities and support to participate in quality improvement activities that lead to improved health outcomes

• enable GPs to fulfil their individual and vocational continual professional development requirements

• meet the needs of individual education interests through the provision of high quality accredited learning activities delivered by RACGP accredited providers

• deliver efficient tracking of continuing professional development points to meet Australian Health Practitioner Regulation Agency (AHPRA) requirements.

QI&CPD Program – triennium handbook overview

This handbook details the range of educational options offered by the QI&CPD Program for the 2014–16 triennium. All participants are encouraged to undertake a range of different activities from across the domains of general practice and the RACGP Curriculum for Australian General Practice 2011 (the Curriculum) to address their individual learning needs.

GPs, providers and practices are encouraged to contact their state faculty QI&CPD unit for advice regarding the program.

2QI&CPD Program2014–16 triennium handbook

Enhancing patient care through quality improvement

Professional advice and a growing body of evidence demonstrate quality improvement activities lead to positive change in practices, particularly when involving a whole practice team approach. Building on the general practice profession’s long standing commitment to excellence in education, the RACGP has introduced a quality improvement requirement for GPs in the 2014–16 QI&CPD triennium.

The RACGP Standards for general practices (4th edition) (the Standards) describes a quality improvement activity as an activity undertaken within a general practice where the primary purpose is to monitor, evaluate or improve the quality of healthcare delivered by the practice. The Standards recommend practices engage in quality improvement activities that review structures, systems and processes to aid the identification of required changes to increase the quality of healthcare delivery and safety of patients.

The RACGP supports GPs with flexible opportunities to reflect and transform conventional educational activities into actions that demonstrate effectiveness in enhancing patient care. Many existing QI&CPD activities meet quality improvement requirements, including:

• Supervised clinical attachment (SCA)

• Plan, do, study, act (PDSA)

• Clinical audit

• GP research

• Evidence based medicine journal club (EBMJC)

• Small group learning (SGL).

The QI&CPD Program is flexible in its approach, enabling GPs the opportunity to self direct learning, recognising activities that review and evaluate a GP’s own practice as fulfilling the quality improvement requirement for the 2014–16 QI&CPD triennium.


QI&CPD Program participation

Australian GPs who are required to demonstrate participation in ongoing continuing professional development, include:

• all registered medical practitioners who are engaged in any form of medical practice under Medical Board of Australia/AHPRA requirements

• GPs who are involved in the process of practice accreditation

• GPs seeking visiting medical officer credentials with local hospitals, particularly in rural areas

• GPs who have a specific requirement with other colleges to maintain recognition of particular skills and qualifications such as women’s health, anaesthesia, surgery, radiology, mental health, and medical acupuncture

• GPs who are on the Medicare Vocational Register, Fellows list, or recognised other medical practitioners.

There is no distinction made between the QI&CPD Program requirements for full time or part time participants. The underlying principle is that the standard of practice required is the same, regardless of whether a participant works full time or part time. Therefore, regardless of the fraction of time worked as a GP, the requirements for maintaining currency in knowledge, skills and practice are also the same.

2014–16 triennium QI&CPD program requirements

Since the first QI&CPD Program in 1987, the RACGP has acted on a commitment to continually evaluate and improve the program.

The 2014–16 triennium requirements are:

130 points 1x CPR course

2x Category 1 activities

including 1x quality improvement activity

The 2014–16 QI&CPD triennium features a number of enhancements that will continue to be offered throughout the triennium period, including:

• personalised ongoing support – Program coordinators in state faculties and RACGP staff available to assist in meeting learning requirements

• high quality education providers – access to an extensive range of well-established, accredited organisations and thousands of accredited activities delivered in a GP relevant format

• enhancing patient care – the introduction of a quality improvement requirement for GPs strengthening the effectiveness of the RACGP QI&CPD Program in accordance with international best practice

• online system improvements – an intuitive online platform has been developed to make it easier to find, record and monitor ongoing QI&CPD activities and access individual point summaries

• AHPRA requirements – recording CPD undertaken and assisting GPs to ensure all requirements are met.


QI&CPD Program

A minimum of 130 points is required for the 2014–16 triennium and must include:

• two Category 1 activities, including 1 quality improvement activity

• a cardiopulmonary resuscitation (CPR) course.

Category 1 Accredited Activity options

Inherent quality improvement activities• Clinical audit (40 points)

• PDSA cycles (40 points)

• Small group learning (40 points)

• Evidence based medicine journal club (40 points)

• Supervised clinical attachment (40 points)

• GP research (40 points)

Other Category 1 Options• Active learning module (40 points)

– Individual GP ALMs

– Educator ALM

– Accredited Activity Provider ALMs

• Peer review journal article (40 points)

• Higher education relevant to general practice

– Graduate Certificate courses (60 points)

– Graduate Diploma courses (90 points)

– Masters Degree (120 points)

– PhD (150 points)

• RACGP Assessment (150 points)

– FRACGP

– FARGP

Category 2 options

• CPR course (5 points)

– must meet Australian Resuscitation Council guidelines

– may be completed as part of a Category 1 Accredited Activity

• Cultural awareness training

• Accredited Activity Provider Category 2 Accredited Activities

– Each activity is capped to a maximum of 30 points

• Individual GP Category 2 unaccredited

– Two points per 1 hour and capped at 20 points per triennium

Quality improvement reflection

Capped at 5 points per activity per year


Educational principles and standards

Effective CPD is understood by the medical profession as educational activities that result in improvement in clinical practice. The educational principles underpinning the QI&CPD Program are directed at learning of enduring value, which is a strong focus of the program. The QI&CPD Program recognises that activities are more likely to achieve these goals if the learning:

• is self directed

• is driven by the learner’s identified needs

• is integrated into an individual’s learning program

• encourages active participation

• involves reflection and evaluation of what has been learned.

The QI&CPD Program respects the learning life of a GP. Accredited Activities within the QI&CPD Program are therefore based on adult learning principles; promote high quality clinical, scientific and ethical standards; and enhance knowledge and skills that impact significantly on the behaviour of GPs in relation to improved quality of care to their patients.

Systems based approach to patient safetyThe focus of the program continues to centre on ensuring the safety of patients through the implementation of appropriate systems as an integral and indispensable part of all Accredited Activities. A systems approach to patient safety considers factors within general practice that may cause harm such as the absence of processes and systems within the practice.

A systems based approach addresses individual weaknesses by building processes that minimise adverse events and variability in healthcare delivery, fostering opportunities for consistently providing high quality care.2 While there is a valid focus on the skills and knowledge of GPs, evidence suggests that attention also needs to be paid to other factors that contribute to harm. This may involve undertaking an assessment of the working environment and identifying unsafe practices, recording of information, and reporting structures to establish a risk minimisation strategy in the practice.3

The RACGP requires developers of Accredited Activities (Education Activity Representatives (EARs) and providers) to indentify effective risk management strategies, within the GP’s practice systems, thereby improving the quality of patient care and safety as they relate to the education being offered. Accredited Activities must include learning outcomes, one of which must focus on a systems based approach to patient safety.1


Education criteria

The 2014–16 triennium specifies that all Accredited Activities have the following mandatory design components:

• The primary outcome must be to improve the quality of patient care.

• The content of the Accredited Activity must be relevant to GPs and general practice.

• The planning must include a learning needs assessment to validate the education activity.

• The content must include clear and measurable learning outcomes.

• The content must demonstrate a systems based approach that can be implemented in a GP’s practice to improve patient safety.

• The content (including reading material and references) must meet or exceed the highest ethical, clinical and educational standards, and the aims and outcomes of the QI&CPD Program.

• The content (including reading material and references) must demonstrate high clinical content reflecting critical appraisal of valid evidence and supported by accepted medical theory about ways to improve patients’ health outcomes, including a balanced appraisal of alternative treatment options for any condition.

• The content must relate to one or more Curriculum areas that are representative of the activity content.

• The content must relate to one or more domains of general practice.

• The content must include identification of specific requirement areas covered in the educational content as applicable.

In addition, Accredited Activities developed by an education provider must have the following:

• A GP medically registered with AHPRA, and recognised as having the Specialty of General Practice must be involved in the planning and development.

• The learning environment must promote fulfilment of the outcomes.

• The content must use presentation and engagement modes appropriate for the content to be delivered.

• The content must take into consideration the prior knowledge, skills, attitude and behaviour of the participants.

• The GP Feedback Form must be made available to GPs who attend/participate in the event at the time the event is delivered.

• Evaluation of the Accredited Activity upon completion.

ALMs must also include:

• a range of teaching/learning strategies within the Accredited Activity

• a minimum of 6 hours structured learning

• more than two-thirds interactive or experiential content

• education that is thematically linked.


Linking the Curriculum and Domains of General Practice to the QI&CPD Program

The RACGP Curriculum for Australian General Practice 2011 details what vocational GPs need to learn throughout their general practice learning life. The Curriculum details the knowledge, skills and attitudes that GPs require for:

• competent, unsupervised general practice

• meeting their community’s healthcare needs

• supporting current national health priorities and the future goals of the Australian healthcare system.

The Curriculum emphasises self directed learning, the development of critical self reflection and lifelong learning skills, and the maintenance of professional practice standards.

From the commencement of the 2014–16 triennium, all Accredited Activities must be mapped to the Curriculum and Domains of General Practice using Table 1. This process involves finding the appropriate Curriculum area and linking to the Domains of general practice. For instance, if the activity is in men’s health, the men’s health Curriculum should be referenced, including the relevant areas in the domains of general practice that will be specifically addressed.


Table 1. Curriculum and Domains of general practice matrix

Domains of general practice

Curriculum Statements

Communication skills and the patient–doctor relationship

Applied professional knowledge and skills

Population health and the context of general practice

Professional and ethical role

Organisational and legal dimensions

General statements

Common training outcomes

Philosophy and foundation of general practice

People and their populations

Aboriginal and Torres Strait Islander health

Aged care

Children and young people’s health

Disability

Doctor’s health

Genetics

Men’s health

Multicultural health

Population health and public health

Rural general practice

Women’s health

Presentations

Acute serious illness and trauma

Chronic conditions

Dermatology

Drug and alcohol medicine


Table 1. Curriculum and domains of general practice matrix

Domains of general practice

Curriculum Statements

Communication skills and the patient–doctor relationship

Applied professional knowledge and skills

Population health and the context of general practice

Professional and ethical role

Organisational and legal dimensions

Eye and ear medicine

Mental health

Musculoskeletal medicine

Occupational medicine

Oncology

Pain management

Palliative care

Sexual health

Sports medicine

Processes of general practice

Critical thinking and research

Undifferentiated conditions

E-health

Multidisciplinary care

Integrative medicine

Quality and safety

Practice management

Procedural skills

Quality use of medicines

Teaching, mentoring and leadership in general practice

Other: please supply further information


Table 2. Domains of general practice

1. Communication skills and the patient–doctor relationship

2. Applied professional knowledge and skills

3. Population health and the context of general practice

4. Professional and ethical role

5. Organisational and legal dimensions

The nature of the relationship between patient and doctor and its therapeutic potential

Consultation models

Patient centredness

The communication skills and attitudes needed to foster effective whole person care

Individualistic and opportunistic health education and promotion

Knowledge of significant medical conditions

Approaches to under differentiated problems

Information gathering

Physical examination skills

Procedural skills

Clinical decision making

Continuity and integration of care

Cost effective investigations and treatment

Rational prescribing

Critical appraisal of professional knowledge and skills

Demographics

Epidemiology

Public health problems and the health needs of special groups

Population based preventive strategies

Sociopolitical and cultural aspects

The influence of family, work and significant others on health advocacy role

Community services

Special duty of care

Maintenance of professional standards

Contemporary ethical principles

Reflective skills and professional self appraisal

Lifelong learning and continuous professional improvement

Role as a teacher, leader and change agent

Research, evaluation and audit skills

Professional networks; maintaining wellbeing of self and family

Availability and accessibility arrangements

Safety netting

Screening and recall systems

Patient and practice related information technology and management

Medical records and legal responsibilities

Reporting, certification and confidentiality

Practice management


Quality Assurance

The primary purpose of all education activities accredited by the RACGP QI&CPD Program is to improve the quality of care provided to patients. The QI&CPD Program is committed to providing GPs with access to the highest quality education through a quality assurance process and continuous quality improvement.

Timely Quality Assurance is fundamental to the integrity of the QI&CPD Program. The RACGP, as the peer representative body for GPs, has a proud reputation in benchmarking professional standards in Australia. All Accredited Activities must meet the high standards of the QI&CPD Program to receive, and continue to enjoy, Accreditation.

Providers must participate in the Quality Assurance process in a prompt and timely manner.

When is the Quality Assurance process initiated?Quality Assurance may be initiated:

• if the RACGP receives a complaint about an Accredited Activity

• as a result of a random inquiry made by the RACGP

– at least 10% of all Accredited Activities will be selected for random assessment over the triennium

• as necessitated by recent medical science demonstrating that medical procedures, once accepted as appropriate, are no longer regarded as safe or advisable

• if it appears that the content of an Accredited Activity is not evidence based, or is controversial in some way.

These examples are not exhaustive and the RACGP may undertake a Quality Assurance assessment in respect of any Accredited Activity at any time.

Consequences of non-compliance Any failure to conform to RACGP standards revealed by the Quality Assurance process, failure to provide materials within the required period or failure to fully participate and cooperate in the Quality Assurance process may result in sanctions being imposed on the Provider and/or its delivery of that Accredited Activity.

These sanctions may include:

• revocation or suspension of the Accreditation of an Accredited Activity

• revocation or suspension of the Provider’s authority to offer and provide Accredited Activities.

GP feedback on education activities

The RACGP welcomes and encourages feedback from participants regarding the quality and conduct of QI&CPD Program Accredited Activities. Education providers are required to make the GP Feedback Form available to all participating GPs at every Accredited Activity.

The RACGP encourages GP participants of Accredited Activities to provide feedback of positive, high quality education experiences. Alternatively, if a GP has concerns about the quality or conduct of a QI&CPD Program Accredited Activity or perceives that a breach of the RACGP QI&CPD education criteria has occurred, the GP is encouraged to complete the GP Feedback Form or report concerns to their state faculty QI&CPD unit, where staff will initiate a Quality Assurance of the Accredited Activity.


Category 1 activities


Clinical audit (40 Category 1 points)

A clinical audit is a planned medical education activity designed to help GPs systematically review aspects of their own clinical performance against defined best practice guidelines. A clinical audit has two main components:

• an evaluation of the care that an individual GP provides

• a quality improvement process.

Research into evidence based medicine supports that a clinical audit is more likely to result in changes in GPs’ behaviour and improvement in practice than didactic medical education methods.

Practice based groups are encouraged to develop clinical audits to investigate issues of relevance to their practice.

A clinical audit compares actual clinical practice against established standards of practice. It must consider ethical, privacy and confidentiality issues relating to patient information. See page 55.

There is more detailed information on privacy at the website of the Australian Government Office of the Australian Information Commissioner (www.oaic.gov.au).

An audit can be undertaken by an individual GP or in a small group with a minimum of two GPs and a maximum of 12 participants. Small group clinical audits with more than 12 participants must discuss their individual needs with their state faculty QI&CPD Program Coordinator.

Data may be collected and collated online or be paper based. Feedback mechanisms vary and may be face-to-face, online or via paper based methods.

Clinical audits can either be of fixed time duration or based on patient numbers, depending on the prevalence of the condition or the audit topic, eg. if presentation is quite rare, the audit may continue for more than 1 year. Other audits are structured around patient numbers, which may include large numbers over a short period.

Criteria specific to the clinical audit• Have a maximum of 12 participants for each group clinical audit.

• Provide a description of the clinical audit and what it involves.

• Supply information on how many patients were audited and how they were selected.

• Document how privacy, confidentiality and consent will be addressed.

• Ascertain whether HREC approval is required.

• Complete the five steps of the audit cycle.

• Complete a quality improvement reflection.


Step 1

Needs assessment

Step 2

Identify standards

Step 3

Data collection and analysis

Step 5

Monitor progress

Step 4

Identify and implement change

Figure 1. Clinical audit cycle

Steps in the clinical audit cycle module1. Conduct a needs assessment – identify valid educational needs, clinical audit outcomes and list

references.

2. Identify standards – list best practice guidelines, develop clinical audit criteria, identify your standards and list references.

3. Data collection and analysis – collect data, complete informed participant consent if required, compare data against standards and reflect on results.

4. Identify and implement change – reflect on results and document proposed changes to practice with the consideration of reliably enhancing patient safety.

5. Monitor progress – evaluate changes, write final report identifying any improvement in patient outcomes and submit record of participation.

Considerations

Needs assessment• How was the learning need identified?

• Provide evidence of the learning need and how it will benefit GPs and the community.

Standards• List of best practice guidelines and references.

• List of clinical audit criteria.

• List of identified standards.


Data collection and analysis• How will the data be collected?

• Who will collate and compare the data?

• Who will collect the data and who will be able to access the data?

Patient selection, privacy and confidentiality• How are patients selected? What is the minimum number of patients for each GP?

• Patient privacy, confidentiality and consent has been addressed and documented.

• Obligations under the privacy legislation have been addressed and documented.

Identify and implement change• How is feedback provided to the GPs?

• Describe how GPs will reflect on and respond to feedback.

• Develop a proposed feedback document.

• Develop the document that will form the GP’s response to their analysis of the data, identify and propose ways that GPs will implement changes to their practice systems.

• Develop an activity evaluation.

Monitor progress• What are the variations that have occurred?

• Describe how you will monitor the variations.

Evidence

Providers

In addition to the online form, providers must document and retain the following evidence:

• needs assessment

• clinical audit plan

• evaluation

• any supporting documentation such as clinical audit guidance and instructions for the GP

• individual GP completion of the quality improvement reflection questions:

– What changes did you implement in your practice as a result of this activity?

– How do you monitor these changes?

– What evaluation process do you use to measure these changes?

GPs

In addition to the online form, GPs must document and retain the following evidence:

• clinical audit plan

• individual GP completion of the quality improvement reflection questions (for group clinical audit activities):





The ‘plan, do, study, act’ cycles (40 Category 1 points)

The ‘plan, do, study, act’ (PDSA) cycles are the implementation of a planned program that has as its primary focus systematic changes in general practice. The PDSA cycles encourage the individual GP or the practice team to implement a planned improvement by breaking down change into manageable parts, and testing each small change to make sure that things are improving and no effort is wasted. It emphasises starting on a small scale and reflecting and building on learning. It can be used to test suggestions for improvement quickly and easily, based on existing ideas and research, or through practical ideas that have been proven to work elsewhere. It is a cyclical model because the benefit is not always achieved in one cycle, so the process can be refined and the cycle repeated.

GPs can choose to undertake PDSA cycles related to practice improvements or improvement of individual clinical knowledge and skills.

The PDSA cycles can be undertaken by an individual GP, a group of GPs, and/or a multidisciplinary team. A whole of practice approach to quality improvement is encouraged.

Practice PDSA cycles are defined as those that focus on improving the capability of the practice to deliver on quality patient care (improving the quality, safety and performance of the practice, ie. meeting RACGP standards, improving systems, process and/or procedures). Group aspects of the PDSA cycle planning and development may be conducted face-to-face, via teleconference or as an online group – a mixture of technology may be used.

Individual GP PDSA cycles are defined as those that focus on improving the individual GP’s clinical performance, clinical knowledge and/or skill.

Criteria specific to the PDSA cycles activity• Group PDSA cycle has a facilitator and a planning and review meeting.

• A minimum of two GP participants and a maximum of 12 participants in a PDSA cycle group activity.

• A minimum of two PDSA cycles must be completed.

• A quality improvement reflection is required.

Steps in the PDSA cycle module1. Select a leader/facilitator and decide who will be in the PDSA group.

2. Discuss the following questions:

• What are we trying to accomplish?

• How will we know that a change has occurred?

• How will we know that a change is an improvement?

• What changes can we make that can lead to an improvement?

• How will patient confidentiality be assured?

3. Select a topic.


4. Start the first PDSA cycle:

Plan• Outline the steps that will be taken

• Who will carry out the plan?

• What information will we collect?

• How will information be collected?

• What is the expected outcome?

Do• Carry out the plan

• Record observations

• Record data

Act• Act on the results

• Adopt, reject or modify original plan as required

Study• Compare the results

to expectations

• Summarise what was learned

Figure 2. PDSA model

5. Develop the second cycle.

6. Develop further cycles as required.

7. At the completion of the PDSA cycles describe what mechanisms have been put in place to promote reliable use of the improvement.

8. Complete the QI&CPD form and submit.

PDSA cycles can be developed in a number of areas, such as:

• providing smoking cessation advice to pregnant women

• recording allergy status

• repeat prescriptions – reduce the number of demands for repeat prescriptions by telephone4

• interdisciplinary information – improve information between GPs and allied health when referring patients by adopting an existing referral form and then increasing its use and evaluating the form4

• privacy – reduce the amount of information patients can overhear at the reception desk and while in the waiting room4

• consistent recording across the practice of various groups of patients, eg. those with diabetes.


Considerations

Needs assessment• How did you identify the learning need?




Plan• Outline the steps that will be taken.

• Who will be responsible for each step and when will it be completed?

• Who else needs to be informed or consulted?

• Determine the time period for the first cycle.

• What would the GPs expect to see as a result of this change?

• How will the GPs determine the effect of the change?

• How will patient confidentiality be assured?

Do• How will the GPs capture the effects of the change?

• What else might happen as a result of the change?

Study• How will you know if there has been an improvement?

• How will improvements be captured and documented?

• Compare the impact of the change to the effort needed to implement it.

• Identify factors that hindered the change.

Act• Document how the next step will be determined.


Evidence

Providers



• PDSA cycles plan

• evaluation

• any supporting documentation such as PDSA cycles guidance and instructions for the GP

• individual GP completion of a quality improvement reflection such as:




GPs


• PDSA cycles plan

• individual GP completion of the quality improvement reflection questions for group PDSA cycles:





Small group learning (40 Category 1 points)

Small group learning (SGL) is designed to maximise the benefits of working and learning together in a small group educational setting. SGL can include other health professionals with peer support, interaction and reflection to enhance their own clinical competence, knowledge, skills, attitudes and performance.

Although the focus of the small group is on learning, the importance of team building in terms of joint responsibility in practice is strengthened.

Small groups are an ideal format for GPs to share their knowledge and discuss their daily practise with peers. A skilled facilitator will assist the group to stay focused and deal with group dynamics effectively and allow participants to take ownership of the process. This will increase the likelihood of members having a positive and rewarding learning experience.5

Evidence shows that when learners have the opportunity to select topics relevant to their own practice and measure their practice against that of their peers, motivation is high and more likely to enhance change in clinical practice.

The cycle may be completed over a short period, but may also span over the 3 years of the triennium, depending on the needs of participants.

Criteria specific to the SGL module• A minimum of two GP participants and a maximum of 12 participants.

• The duration of each meeting is at least 1 hour.

• A minimum of 6 hours meeting time must be completed by all members for each SGL cycle in order to obtain Category 1 points (excluding planning and review meetings).

• Must have a facilitator.

• Must convene, attend and document a planning meeting and a review meeting.

• Quality improvement reflection is required.

Steps in the SGL cycle module1. Identify interested participants.

2. Identify a group facilitator and someone to organise the group – facilitators are encouraged to undertake facilitator training and keep a facilitator’s reflective diary.

3. Each participant agrees to identify and reflect on his/her personal learning needs in relation to this group before the meeting.

4. Hold an orientation and planning meeting – review the issues and options for the group and develop a program of continuing professional development activities (topics, dates).

5. Undertake the program of activities.

6. Hold a review meeting at the end of the cycle to reflect on the outcomes of the group.

7. Complete an SGL form.


Considerations

Facilitator• Identify the facilitator.

• Determine and document the role of the facilitator.



SGL plan• Identify the learning needs of each participant.

• Prepare the schedule for the small group, including the planning and review meetings.

• Identify the process for developing each session.

• Identify how GPs will integrate the learning into their own professional practice.

Evidence

Providers


• details of facilitator


• agenda for each session detailing topics (including orientation/planning and review meetings)

• evaluation

• any supporting documentation such as small group learning guidance, program and instructions for the GP





GPs



• agenda for each session detailing topics (including orientation/planning and review meetings)

• any supporting documentation such as small group learning guidance, program and instructions






Evidence based medicine journal club (40 Category 1 points)

Evidence based medicine journal clubs (EBMJCs) encourage GPs to discuss questions that arise in their day to day clinical practice and assist GPs to solve clinical questions in a peer supported environment. It has been shown that EBMJCs are more successful in changing GP behaviour and improving patient care6 than more traditional journal clubs that discuss recent journal articles, without directly focusing on clinical relevance.

While medical journal clubs have a long history,7,8 traditional journal clubs differ from EBMJCs in that they encourage GPs to discuss evidence that may or may not be directly relevant to a clinician’s daily practice. However, EBMJCs encourage GPs to take note of clinical questions that arise in day to day practice and to then follow up these questions by researching evidence, thereby assisting GPs to relate evidence directly to clinical practice.

There must be a minimum of two GPs and a recommended maximum of 12 participants (including other members of practice team, eg. practice nurse). EBMJCs with more than 12 participants must discuss their individual needs with their state faculty QI&CPD Program Coordinator.

Members of the group may wish to complete a critical thinking course.

Clubs can be conducted face-to-face or via teleconference.

EBMJC formats can vary, however, their success has been shown to depend on a number of common characteristics listed below.6

• A trained facilitator leads the group.

• One person in the group has suitable experience in critical appraisal skills.

• One person takes responsibility for note taking.

• One person offers administrative support (eg. copies articles).

• A voting system is employed to establish the most popular questions to be addressed.

• Someone is allocated the task of completing a brief literature search as homework.

• The club starts with a review question and allows at least 5 minutes to scan articles.

• There are sufficient copies of articles, including backups in case the questions have limited available literature or there is time lag in receiving information from a library.

• There are copies of one page appraisal tools or EBMJC validity criteria.

• A learning log book is created to record the questions and results.

• There is sufficient time allocated to appraising papers that represent the best answers, if necessary time can be allocated over a number of sessions to ensure the question is answered thoroughly.

• The last 10–15 minutes of a session is spent discussing participants’ real clinical problems and defining structured clinical questions that would help address problems.

• The club finishes with a ‘bottom line’ or discussion about how to change practice in relation to what has been discovered (stay clear of unusual or rare diagnoses and stick to more everyday practice).

• Be prepared with dilemmas and questions just in case participants have not had the chance to collate clinical questions.

Despite all of the positive influences on patient care that EBMJCs can bring, the literature suggests it is important to be aware of the limitations of critical appraisal in that it suggests that by examining the content of publications alone one can assess the truth of their conclusions. 9,10

It has been argued that critical appraisal only examines validity or methodology of the study and does not consider whether the interpretation of the original data is sound or true. Study findings can often be determined by powerful influences and it is important to be aware of the context in which the evidence is generated so that a true picture of the findings can be created.10


The appropriate use of subject matter experts to guide clinical decisions within an EBMJC is particularly important where study findings are outside clinical guideline recommendations.

The RACGP QI&CPD Program has designed an EBMJC module based on three core strategies that overcome the gaps in evidence based practice:

• keep a logbook of clinical questions

• read an evidence based abstraction journal

• run a case based discussion journal club.

When an EBMJC is based on individual patient queries, used as part of an evidence gathering process and discussed with colleagues, it offers an attractive quality improvement activity that has variety, currency and immediacy.

Criteria specific to EBMJCs• Meetings must be a minimum of 1 hour.

• Minimum of 6 hours meeting time must be completed by all members of each EBMJC cycle to obtain Category 1 points.

• Minimum of two GP participants and a maximum of 12 participants.

• Each GP participant must complete one literature review and present results of the literature review to the group.

• Articles reviewed should be from peer reviewed journals.

• The group must complete a quality improvement reflection or each GP must complete an individual quality improvement reflection.

• Each EBMJC must record:

– clinical questions discussed

– reflection on aspects of practice systems that would support reliable use of learning derived from journal papers

– a summary of the outcomes for each meeting.

• Must convene and document planning and review meetings.


Steps in the EBMJC module1. Nominate a facilitator.

2. Each GP participant keeps a log of potential questions that arise in their clinical practice.

3. Each GP participant brings their potential questions for discussion.

4. The group agrees on a question to be discussed.

5. Nominate a member from the group to complete a literature search to answer the clinical question.

6. The nominated member distributes the relevant papers to the group.

7. At the beginning of each session, ask the person initiating the question to explain the clinical background.

8. Discuss results of the search and papers chosen for discussion.

9. Discuss and critically appraise each paper.

10. Discuss how the results might enable change in clinical practice at either an individual or whole of practice level.

11. Document the outcomes of each session.

12. Discuss potential questions for the next meeting and begin the cycle again.

Considerations

Facilitator• Identify the facilitator.

• Determine and document the role of the facilitator.



Session planning• Identify and document the questions raised by the participants.

• Prepare the schedule for the group, including the planning and review meetings.

• Identify the process for developing each session.

• Identify how GPs will integrate the learning into their own professional practice.

• Identify how the implemented changes can be measured and reviewed.


Evidence

Providers




• session summaries including topics, presenters and references

• evaluation

• any supporting documentation such as EBMJC guidance and instructions for the GP





GPs



• session summaries including topics, presenters and references

• any supporting documentation such as EBMJC guidance and instructions






Supervised clinical attachment (40 Category 1 points)

The aim of supervised clinical attachments (SCAs) is to update specific areas of knowledge and skills by working alongside health professionals in the chosen area. They are designed to provide an individualised learning experience and are an active, hands-on mode of learning, where the examples, scenarios and problems are real cases. GPs have the opportunity to develop individual learning outcomes and use the supervised environment to investigate, learn and increase their skill base in a manner that is unique to them.

Some of the contact hours can be delivered face-to-face, or in combination of face-to-face with other media such as web cams, video, video phones, teleconferencing, case study discussions over the phone, email or online discussion groups

This activity is suitable for GPs who have identified a particular skill they may wish to upgrade or develop. A supervisor with the relevant expertise and skill set must be appointed to conduct the supervision. The GP spends a minimum of 10 hours working, observing and undertaking practice with the supervisor. Education providers may also develop SCA programs for GPs.

What is expected of the supervisor?

• The supervisor does not need to be a clinical expert but may be another health professional with highly developed skills in a specific area.

• The supervisor must schedule an appropriate amount of time for the GP to visit.

• The supervision can take place face-to-face, with portions of contact time either by email, phone or other modes of technology suitable to both parties.

• Provide the GP with opportunities to observe patient care, using specific skills (eg. psychological treatment, specific procedural skills such as excising moles or assisting a new mother with breastfeeding).

• Provide the opportunity for frank discussion of cases, treatments and the GP’s skills. These could take the form of end of session debriefs or reviews.

Criteria specific to the SCA module• Minimum of 10 hours contact with the supervisor.

• Record the name and qualifications of the supervisor.

• Record details of each session.

• Complete a quality improvement reflection.


Steps in the SCA module1. GP identifies the special skills or areas they have decided to update.

2. GP identifies a health professional willing to act in the role of supervisor.

3. GP provides the supervisor with relevant documentation.

4. GP identifies learning needs, formulates specific learning outcomes, which must include one about systems that support consistent application of skills and knowledge and ways these will be achieved.

5. GP records these needs and outcomes to aid planning and evaluation with their supervisor.

6. GP or provider gives a copy of learning outcomes and needs to the supervisor.

7. GP completes session summaries for each session of the SCA.

8. GP completes reflection after completion of the SCA.

9. GP submits the completed form and retains all documentation.

Considerations



SCA plan• How was the supervisor identified?

• Is there a briefing document for the supervisor?

• Is there a briefing document for the GP?

• Can you capture session summaries?

• How will you capture the supervisor discussion and GP reflection on the cases?

• How will you identify how GPs will integrate the learning into their own professional practice?


Evidence

Providers


• name, qualifications and contact details for the supervisor


• completed session summaries

• evaluation

• any supporting documentation such as guidance and instructions for the GP and supervisor





GPs


• name, qualifications and contact details for the supervisor

• completed session summaries.


GP individual or group research (40 Category 1 points)

Participating in research offers many benefits for GPs such as:

• access to the latest evidence

• opportunities to collaborate with or be mentored by other GP researchers

• opportunity to refine research writing skills.

It is important that research is undertaken in the Australian general practice setting, ensuring that research is relevant, applicable and manageable within the average practice for Australian patients. This QI&CPD Program activity has been designed to provide GPs with an additional incentive to participate in research that focuses on actual research skills development and reflective and critical thinking.

The GP research activity is designed to:

• encourage GPs to become actively involved in designing and conducting quality research activities

• disseminate the results of primary health care research to benefit the Australian general practice population.

GPs can participate as either principal investigators or participants. Both roles are eligible for Category 1 points in the QI&CPD program.

The principal investigator organises the research project and acts as the education provider and can be an individual GP, Medicare Local, university, research institute or other organisation.

Research may be funded, seeking funding or unfunded and must have the necessary HREC approval as appropriate.

Groups of more than 12 participants should seek advice from their state faculty QI&CPD Program Coordinator.

Criteria specific to GP research groups• Minimum of two GPs and maximum of 12 participants for group research.

• Obtained the approval of an HREC if required.

• Completed a quality improvement reflection.

• Completed documentation of the research proposal, report and dissemination.

Criteria specific to GP research – Individual participant• Completed a record of enrolment.

• Completed a quality improvement reflection.

• Completed documentation of the research proposal, report and dissemination.

Steps in the GP group research module1. Define the research question.

2. Design the research study and/or write the research funding proposal, detailing GP participants as required.

3. Obtain ethics approval for the research study from an HREC constituted under NHMRC guidelines, eg. RACGP National Research and Evaluation Ethics Committee (NREEC).


4. Implement the research module for GP research participants.

5. Conduct the research within ethics parameters and either be involved in, or supervise the analysis of the data collected.

6. Provide a report of the findings from the research study to all GP research participants.

7. Disseminate the findings of the study:

• publication in a peer reviewed journal

• presentation at a conference (oral or poster).

Evidence of the dissemination of research findings needs to be submitted to your state QI&CPD unit upon research completion. This may include a copy of:

• a letter of article acceptance from a peer reviewed journal and a copy of the article

• an article published in a peer reviewed journal

• a copy of the abstract and acceptance letter from a conference to present either a poster or oral presentation

• a conference abstract and a copy of the conference program including the project title and researcher’s name

• the RACGP final grant report and documentation of its submission to the College.

Steps in the GP individual research module1. GP enrols in the research activity.

2. GP reads all materials provided by the principal investigator.

3. GP defines own outcomes for participating in the research study.

4. GP collects data as specified by the principal investigator using the data collection tools provided.

5. GP conducts own analysis of the data collected and submits an individual report of findings to the principal investigator within a given timeframe and within ethics parameters.

6. GP receives and reviews a report of findings from the principal investigator.

7. GP compares own data to the overall study results and submits a brief final research report to the principal investigator.

Considerations



Human Research and Ethics• Does this research require approval from the HREC?

Data collection and analysis• How will the data be collected?

• Who will collect the data and who will be able to access the data?

• Who will collate and compare the data?



• List of clinical audit criteria.


Patient selection, privacy and confidentiality• How are patients or participants selected? What is the minimum number of participants for each GP?

• Patient privacy, confidentiality and consent has been addressed and documented.

• Obligations under the privacy legislation have been addressed and documented.

Evidence

Providers


• needs assessment including appropriate references

• ethics committee approval certificate as applicable

• document for patients/participants outlining the research and their role and rights

• evaluation tools

• research plan

• research report

• acceptance for publication in a peer review journal as applicable

• any supporting documentation such as documents that provide guidance and instructions for the GP and participants





GPs


• ethics committee approval certificate as applicable

• document for patients/participants outlining the research and their role and rights

• evaluation tools

• research plan

• research report

• acceptance for publication in a peer review journal as applicable

• individual GP completion of the quality improvement reflection questions for GP group research activities:





Active learning module (40 Category 1 points)

Active learning modules (ALMs) provide structured, quality education opportunities directed to achieving demonstrable changes in the performance, knowledge, skills, behaviours and attitudes of GPs. Importantly, they also must consider the systems within a practice that address patient safety.

Examples of ALMs

• Individual GP ALMs

• Educator ALM

• Accredited Activity Provider ALMs.

The ALM takes the adult learner through a learning cycle involving the following processes:

• Self reflection: What do I need?

• Planning: How will I do it?

• Action: Carry out the plan

• Review: Did I meet my need?

• Plan: To meet further learning needs.

Research shows that the most effective education methods include interactive educational meetings and strategies that involve multiple educational interventions. The least effective methods are lecture format, teaching and unsolicited printed material, including clinical guidelines. The ALM has been designed to encourage active learning via at least two-thirds interactive and/or experiential learning modes.

Criteria specific to ALMs• Minimum of 6 hours of structured educational content (excluding registration time, meal breaks, sponsor

presentations).

• More than two-thirds is interactive or experiential (may include question and answers, role plays, discussion, case studies).

• Education content must be thematically linked.

• Provider ALMs must have predisposing and reinforcing activities.

Individual ALM for GPsGPs may develop an individual ALM to suit their own learning needs. In recognition of the many activities GPs complete related to teaching and supervision, the RACGP has developed a framework for the development of individual ALMs in these areas.

Steps in the individual ALM for GPs1. Select an area of learning you wish to develop.

2. Set personal learning outcomes.

3. Complete a minimum of 6 hours of active learning on your chosen topic (a combination of different activities may be used).


4. Reflect on the learning and consider ways in which future ALM activities could be improved.

5. Implement change in your clinical practice and/or practice systems that will reliably improve patient safety.

6. Complete and submit an individual ALM form.

Steps in the Provider ALM1. Form a planning committee and complete a needs assessment for the activity.

2. Submit an application to the QI&CPD Program.

3. Register GPs who have indicated an interest in attending the activity.

4. Implement a predisposing activity.

5. Implement a structured learning activity.

6. Implement a reinforcing activity.

7. Send certificates of attendance to GPs.

8. Conduct an impact evaluation.

9. Submit an activity report and attendance list to the state faculty QI&CPD unit.

The ALM must meet QI&CPD Program requirements and the expressed needs of GP participants – ALMs consist of three components:

1. A predisposing activity

A predisposing activity involves the GP’s identification of a perceived learning need which enhances skills and systems in accordance with the aims of the QI&CPD Program. This activity assists Providers to focus on the specific needs of GP participants. It must include one or more of the following exercises to be completed by GPs before they commence the structured learning activity of the ALM:

• reading articles

• collecting some data

• writing case studies

• defining a series of activities to aid learning

• undertaking self reflection, which may occur through answering pre and post tests, multiple choice questions or answering specific questions.

2. The structured learning activity

This activity, properly designed in accordance with the criteria, has as its goal effective learning. The activity should be developed and presented using a range of interactive methods such as role plays, case studies discussed in small groups, demonstrations, practical sessions, online activities (eg. online discussion/chat forum, posting responses/feedback, relevant visuals for feedback). Didactic lectures, question/answer time, printed material/handouts can also be used, however, these formats should not constitute more than one-third of the structured learning activity. The structured learning activity should be no less than 6 hours and can be split over a series of educational sessions or presented as a complete 6 hour activity. The structured learning should be thematically linked.


3. A reinforcing activity

This is the final learning activity of the ALM and should allow the participating GP sufficient reflection time on the first two activities of the ALM. This activity can include post testing in the form of a questionnaire, discussions, revision of case studies and/or intentional statements (eg. GP identifies systems/processes they will implement in their practice as a result of the education activity).

Each component of the ALM should relate to the others and links between all sessions should be clear. Components should not include meals and trade displays or promotion of products in activity time.

It is expected that after completion of the three ALM components, a perceived or demonstrated change in GPs’ performance, knowledge, skills, behaviour and attitudes, as well as a change to systems in the practice, will occur.

Provider ALMs must also include:

• a completed needs assessment

• specific achievable and measurable learning outcomes with one learning outcome addressing practice systems that enhance patient safety

• a link to the Curriculum and Domains of general practice (Table 1)

• a thorough agenda for the complete module, outlining the major themes, learning outcomes and formats to be used

• a description of how the education will be delivered

• if there is a group component, the group size is limited to 25 participants per 1 facilitator.

To complete the ALM process, the provider must:

• deliver a certificate of attendance to all GP participants upon completion of the activity

• provide an evaluation to all GPs in attendance at the activity

• complete and submit an activity report using the standard activity report template provided by the QI&CPD Program that incorporates GP responses to standard questions

• complete an attendance list and submit within 1 month of completion of the ALM

• make available to all GPs who attend/participate in a QI&CPD Program Accredited Activity a copy of the GP Feedback Form.

Providers may be advised of further resources available to them by RACGP staff at the time of application submission.

Considerations



Predisposing and reinforcing activities for ALMs delivered by providers• How will the predisposing and reinforcing activities be distributed to participants?

• How do the predisposing and reinforcing activities add value to the main educational content?

• Do the predisposing and reinforcing activities encourage GPs to reflect on their own professional practice?

ALM program• What types of interactivity are included?


• Is there sufficient interactivity?

• How is the activity thematically linked?

Participants• How many GPs will attend and how many facilitators will be required?

• How will I brief each participant and provide details on the activity and the expected learning?

• How will each participant take that learning back to their own professional practice?

Evidence

Providers


• predisposing activity

• program or agenda

• reinforcing activity

• name and qualifications of each presenter

• evaluation process

• any supporting documentation such as guidance and instructions for the GPs participating.

GPs


• program or agenda (if applicable)

• any relevant supporting documentation such as a certificate of attendance.


Educator ALM (40 Category 1 points)

The Educator ALM is for those who teach medical students, supervise registrars or Prevocational General Practice Placement Program (PGPPP) participants. It focuses on the teaching experience and learning outcomes for the educator.

Under the AGPT guidelines, GP supervisors are required to have at least 4 years practical experience and to have the additional clinical skills required to meet the particular needs of their practice population. It is important for supervisors to have a solid background in order to confidently guide and assist the registrar to prepare for FRACGP or FACCRM examinations.11 GP supervisors need to be able to engage registrars in their learning in an active way, using relevant problems and group interaction, setting clear goals and outcomes.

In line with the Curriculum,12 teaching and mentoring requires a degree of sharing of the teacher’s clinical expertise. This requires good communication skills to make certain the messages are heard. Receiving feedback from the registrar you are supervising is an important part of this learning process. Listening to the learner’s needs ensures that teaching occurs at the appropriate level and in the appropriate context. Reflection and discussion is also an important tool in general practice in order to improve teaching outcomes in the future.

Steps in the educator ALM1. Outline the planning, teaching and evaluation process undertaken.

2. Include the learning program for the GP registrar/medical student/PGPPP candidate whilst they are at the practice. Please note the program outline must include a minimum 6 hours of supervision.

– Trainer must provide a planned educational program. This should include teaching and discussion with the student.

– Practice based teaching

– Patient consultation time.

Criteria specific to the educator ALM• Minimum of 6 hours of teaching and student engagement

• Provide an education summary.


Considerations• Describe the orientation and briefing which was provided to the learner.

• Describe the educational resources which were made available (access to online medical journals, access to gplearning, shared educational program with RTP) other internet sites.

• What teaching skills, techniques and strategies did you use? Were they successful? How did you know?

• Did you access evidence based theory via the Cochrane Library, BMJ, National Health and Medical Research Council or other web based resources?

• What textbooks, articles, and RACGP publications such as The Vocational Training Standards for general practices did you use as teaching tools?

• How did you evaluate your own performance as a supervisor/educator? Give examples.

• What tasks did you assign the GP registrar/medical student/PGPPP candidate to do?

Evidence

Providers


• learning program, including teaching approaches and tools and number of hours supervising

• evaluation by the students, registrar or PGPPP candidate

• self evaluation.


Peer review journal article module (40 Category 1 points)

A peer review journal article is a written article that has been published or been accepted for publication after going through a peer review publication process. It uses high quality, evidence based references, guidelines or best practice standards or is about research results relevant to general practice.

Criteria specific to peer review journal article modulesThe individual peer review journal article module needs to:

• be relevant to general practice

• use high quality, peer reviewed evidence or accepted theory

• link to the Curriculum and one or more Domains of general practice

• lead to improvement to the quality of general practice

• be based on a personal need that relates to your practice and patients

• lead to improvement of prior knowledge, skills, attitudes and behaviour

• be specific, achievable and measurable learning outcomes with at least one learning outcome addressing practice systems that improve patient safety

• include a reflection component.

Steps in the peer review journal article module1. Write peer review journal article.

2. Peer review journal article accepted for publication.

3. Provide a copy of the article to the QI&CPD Program within 12 months of publication or completion.

Evidence

Providers


• published peer review journal article

• acceptance for publication.


Higher education

GPs may wish to enrol in and complete formal qualifications to advance their knowledge of topics relevant to general practice.

Details of eligible courses can be found on the Australian Qualifications Framework (AQF) website (www.aqf.edu.au). Courses accredited under the higher education sector of the AQF will be eligible for Category 1 points, subject to the content of the course relating to general practice. Some courses not accredited under the higher education sector of the AQF may be eligible for CPD points and will be adjudicated on their own merits.

GPs can apply for CPD points when the course is completed or at the end of the triennium for pro rata point allocations. A copy of the components of the course completed, academic transcript or a satisfactory progress report from the university or course provider is required if applying for pro rata point allocations. GPs seeking pro rata points must contact their state faculty QI&CPD Program Coordinator.

University or other higher education institutions can apply for CPD points on behalf of GP participants and GPs need to submit their RACGP reference number to the university or higher education institution during the enrolment process.

Although completion of some courses may give GPs a higher number of points than the required 130, GPs will still be required to complete a second Category 1 activity and the mandatory CPR course during the triennium.

Points will be awarded on successful completion of the following:

• Graduate Certificate (60 points)

• Graduate Diploma (90 points)

• Masters Degree (120 points)

• Doctor of Philosophy (150 points).

Criteria specific to higher education• Is a postgraduate course.

• Is relevant to general practice.

• Organisation is accredited by AQF.

• Course is accredited by AQF.

Evidence

Providers

In addition to the online form, providers and GPs must document and retain the following evidence:

• organisation and course provider details

• evidence of completion/transcript/progress report

• details of course completed and relevance to general practice.

http://www.aqf.edu.au


Fellowship of The Royal Australian College of General Practitioners (150 Category 1 points)

Attaining Fellowship of the RACGP (FRACGP) qualifies the GP for 150 Category 1 points. There are currently various formats for completion of the FRACGP assessment process. Further options and formats may become available over the course of the 2014–16 triennium. Eligibility and enrolment information is available through the National Assessment Department on 1800 626 901 or, if calling from overseas, +61 3 8699 0454, or by visiting the RACGP website.

• Points are allocated to GPs who successfully complete the FRACGP assessment process within the 2014–16 triennium.

• Points are allocated at the time the RACGP Council ratifies Fellowship, as this is considered to be the completion of the FRACGP assessment process.

• GPs who successfully complete the FRACGP assessment process during the 2014–16 triennium will satisfy their QI&CPD Program requirements and will not need to complete a second Category 1 activity.

• Completion of CPR within the triennium will need to be demonstrated.


Fellowship in Advanced Rural General Practice (150 Category 1 points)

The Fellowship in Advanced Rural General Practice (FARGP) is a practice based, postgraduate award designed to assist candidates to increase competency and confidence to work in rural and remote general practice. The program is flexible and consists of core and optional educational activities which have a strong experiential focus. Currently this fellowship involves 720 hours of learning (normally over 2–4 years) consisting of:

• advanced rural skill posts (ARSPs)

• working in rural general practice module

• emergency medicine module

• self identified learning activities.

This is a portfolio based course by distance education where evidence of learning and meeting program requirements is necessary for final assessment at completion of study. Full course materials, curriculum and portfolio guide are provided. GPs working toward vocational FRACGP may work toward the FARGP at the same time. Newcomers to Australian general practice have also found the core modules for this course helpful in rural orientation. The following requirements can be met either before or during completion of the FARGP curriculum by a combination of time in training and/or as a practising GP. Recognition of prior learning is possible for up to 50% of the qualification.

Requirements

• GP registrars must complete a minimum of 12 months training in accredited rural training posts.

• Award of the FRACGP.

• 12 months in accredited Advanced Rural Skills Post.

• Practising GPs must have 12 months of rural experience in Australian general practice and be practising a minimum of three sessions per week in general practice to be eligible for enrolment.

• Points are allocated at the time the RACGP Council ratifies FARGP as this is considered to be the completion of the FARGP assessment process.

• GPs who successfully complete the FARGP assessment process during the 2014–16 triennium will satisfy their QI&CPD Program requirements and will not need to complete a second Category 1 activity.

• Completion of CPR within the triennium will need to be demonstrated.


Category 2 activities


Accredited Activity Provider activities (Category 2 points)

Category 2 activities developed and delivered by Accredited Activity Provider organisations are specifically relevant to GPs and general practice. Such activities are subject to evaluation and the continuing quality assurance process, which is conducted randomly to ensure that activities accredited by the QI&CPD Program continue to meet high standards and criteria.

The QI&CPD Program will only accredit the following types of activities under the Category 2 framework:

• Accredited Activity Provider Category 2 activities

• CPR courses (minimum 1 hour) that meet ARC guidelines (5 points)

• cultural awareness activities.

Participation in Category 2 activities is optional and each activity is capped to a maximum of 30 points.

Criteria for all Category 2 activities• The primary objective is to improve the quality of patient care.

• The content of the activity must be relevant to GPs and general practice.

• A GP must be involved in the planning and development of the activity.

• Planning must include a learning needs assessment to validate the education activity.

• Clear and measurable learning outcomes must be included.

• The content must observe the highest ethical standards.

• The content must be of a high clinical standard which is evidence based and supported by accepted medical theory.

• Use a range of presentation and engagement modes.

• Account for prior knowledge, skills, attitude and behaviour.

• Demonstrate a systems approach that can be implemented in a GP’s practice to improve patient safety.

• The content must relate to one or more the Curriculum areas that are representative of the activity content (Table 1).

• Identify specific requirements covered in the educational content.

• Evaluate the activity upon completion.

• Make available to GPs who attend and/or participate in the event with the GP Feedback Form at the time the event is delivered.

Evidence

Providers


• needs assessment including references

• program or agenda

• evaluation form.


Cardiopulmonary resuscitation (5 Category 2 points)

The RACGP recognises that cardiopulmonary resuscitation (CPR) skills are used infrequently, and thus may diminish. Evidence suggests the most important determinant of survival from sudden cardiac arrest is the presence of a trained rescuer who is ready, willing, able and equipped to act.13

Furthermore basic life support skills are expected of healthcare providers as part of their duty to respond.The RACGP Standards for General Practice (4th edition) recommends ‘practices need to have the necessary equipment for comprehensive primary care and resuscitation’.14

The RACGP Standards recommend undertaking a refresher in CPR competence every 3 years.14

The Australian Resuscitation Council (ARC) guidelines recommend that updates should be completed at least annually (www.resus.org.au). In support of the RACGP Standards and the latest evidence, it is a requirement of the QI&CPD Program that GPs maintain basic life support skills through the completion of a CPR course that meets the ARC guidelines.

The intention of the CPR requirement is to ensure all Australian GPs maintain their skills and competency to perform CPR procedures on a patient or member of the community as and when it is needed. GPs have a duty to respond to sudden cardiac arrest and are expected to perform CPR procedures in accordance with current ARC guidelines and techniques, without the assistance of specialist emergency services or equipment if required to do so.

Criteria specific to CPR• GPs are required to complete a CPR course that meets the ARC guidelines.

• Courses must be a minimum of 1 hour.

• Courses can be either a Category 2 Accredited Activity or form part of a Category 1 Accredited Activity.

• Emergency Management Courses that includes CPR assessment as part of the content of the activity will meet CPR requirement.

• GPs working in anaesthetics or emergency medicine need to supply current evidence of training in CPR or ALS.

• ALS meets the RACGP CPR requirements.

• GPs who cannot physically perform the CPR will need to:

– provide a medical certificate or declaration stating that the GP has a disability or medical condition that prevents the GP from physcially being able to perform CPR

– inform the RACGP in writing about measures undertaken within the GP’s medical practice to ensure the GP is prepared for a situation requiring CPR.

• Training courses are required to assess CPR competence. At the completion of the course learners must be able to physically demonstrate CPR on a manikin.


CPR trainer/GP educator requirementsARC representative members which includes training delivered by:

• Fellows of FACEM and ANZCA in rural Emergency Departments

• The following organisations:

– St John Ambulance Australia, College of Emergency Nursing Australasia, Australian Red Cross, Council of Ambulance Authorities, Surf Lifesaving Australia, Australian College of Nursing, Paramedics Australia, Royal Australasian College of Surgeons, Australian and New Zealand Intensive Care Society, Royal Australian College of General Practitioners, Australian and New Zealand College of Anaesthetists, Australasian College of Emergency Medicine, Royal Life Saving Society Australia, Heart Foundation, Australian Defence Force, Australian College of Critical Care Nurses and Cardiac Society of Australia and New Zealand.

OR

– Organisations that are RTO credentialed to deliver Provide CPR.

– Instructors who deliver CPR training to GPs must hold a current and valid CPR trainer certificate that complies with the policies of the ARC and RTO standard HLTAID001. CPR courses delivered by instructors who do not hold a current valid trainer’s certificate will not be accepted by the QI&CPD Program.

• GPs that have a current CPR trainer certificate (that complies with the policies of the ARC) or can demonstrate the equivalent (as stated above) are exempt from having to complete a CPR course throughout the triennium.

• HLTCPR211A is valid until 1 July 2014 and after this date CPR should be provided under HLTAID001 unless the RTO provides satisfactory documentation of approved extensions to deliver HLTCPR211A.


Self directed activities


Self directed activities

The RACGP understands that it is important to recognise education that GPs see as personally valuable to their education so GPs can self direct activities that the QI&CPD Program have not accredited. This provides GPs with increased flexibility and choice, and acknowledges the value of a diverse range of educational activities to the GP on an individual basis. The RACGP supports all GPs in achieving their personal education needs.

The QI&CPD Program recommends that GPs retain details and evidence of participation for future reference.

All Self directed activities submitted to the RACGP are subject to Quality Assurance.

GP self directed learning

Category 1 ActivitiesGPs may complete an individual application for Category 1 activities where the provider has not applied for QI&CPD points or where a GP has self directed their education.

Category 2 unaccredited activities

Participation in unaccredited activities is entirely optional and, if chosen, GPs can record their attendance, via the online system which has been developed and implemented to facilitate and streamline this process for GPs.

GPs can record an unlimited number of Category 2 unaccredited activities, however, QI&CPD points are capped at 20 per triennium.


Quality improvement reflection

For the purposes of the QI&CPD Program, GPs must demonstrate that they regularly participate in activities that review and evaluate the quality of their work. As such, this triennium the requirement for a quality improvement activity recognises the need for review of and reflection on completed education. Involvement in quality improvement activities is expected at least once every triennium, however, the extent and frequency will depend on the nature of the activity.

Quality improvement activities should be robust, systematic and relevant to a GP’s scope of practice. They must include an element of evaluation and action, and, where possible, demonstrate an outcome or change.

The QI&CPD Program recognises that quality improvement activities can take many forms. Inherent quality improvement activities are listed on page 5. These activities are recognised as promoting Quality improvement through demonstrated applied knowledge.

Quality improvement is the process where an opportunity to change practices occurs as a result of learning. The Quality improvement reflection encourages self reflection of completed Category 1 activities (such as Provider ALMs) where Quality improvement is identified as part of the learning process. GPs may have conducted a review of clinical outcomes, case reviews and evaluation of impact to identify that Quality improvement has occurred within the GP’s individual practice.

The GP is encouraged to document and demonstrate, via the quality improvement reflection, applied knowledge or change in behaviour as a result of a particular learning activity. This activity can be repeated throughout the triennium in order to document the ongoing changes as a result of a learning activity.

Criteria specific to Quality improvement reflection• GP reflects on changes in their practice as a result of the learning.

• Activity is completed as an extension of a Category 1 Accredited Activity where participation has occurred within the triennium. Will not be a new Category 1 Accredited Activity.

• Completed at any time within the triennium.

• Can be completed multiple times within the triennium for the same activity.

• Can be completed for any Category 1 Accredited Activity and fulfils the quality improvement requirement where the original Accredited Activity was not an inherent quality improvement activity.

No more than 5 points per activity per year and capped at 15 points for the triennium.

Steps in quality improvement reflection1. Active participation in an activity or education relevant to your practice.

2. Evaluate and reflect on the results.

3. Take action.

4. Demonstrate an outcome or maintenance of quality.


General information


Rural Procedural Grants Program

The Rural Procedural Grants Program (RPGP) offers rural and remote procedural and emergency medicine GPs financial assistance to access skills maintenance and upskilling activities in their respective disciplines. GPs providing services in rural and remote areas but residing primarily in urban areas (eg. locums, Royal Flying Doctor Service doctors) may be eligible for participation in the program.

Grants are offered to GPs and locums who practise unsupervised obstetrics, anaesthetics, surgery and/or emergency medicine in rural and remote locations.

The financial support is offered as a grant of $2000 per day for up to 10 days per year for procedural GPs in Rural, Remote and Metropolitan Areas (RRMA) 2–7 and for up to 3 days per year for emergency medicine GPs in RRMA 3–7. To receive the grant, you must be registered in the grants program before attending grant approved training.

For further information about the procedural skills training grant contact the RACGP National Rural Faculty on 1800 636 764 or visit www.racgp.org.au.

The practice team

The RACGP supports and promotes a whole of practice team approach to ongoing continuing professional development and continuous quality improvement activities. The RACGP is committed to providing GPs, allied health professionals and practice staff with opportunities to share learning experiences and to engage in the continuous quality improvement process. Particularly, the QI&CPD Program, Australian Practice Nurses Association and Australian Association of Practice Managers have been working in collaboration to ensure practice nurses and practice managers who participate in RACGP accredited activities receive appropriate recognition within their own professional CPD programs.

Skilled practice staff and allied health professions are valued members of the practice team and are essential to the achievement of high quality general practice in Australia.

Quality improvement activities can be designed to improve the day to day operations of the practice (eg. improving patient health record keeping, changing the way patient complaints are handled, or altering systems in response to ‘near misses’), or to improve the health of the whole practice population (eg. improving rates of immunisation, improving care of patients with diabetes, or altering the systems used to identify risk factors for illnesses that are particularly prevalent in the practice’s local community).

Category 1 modules such as PDSA cycles, clinical audit and SGL are structured activities that can be completed by the practice team and there are many preapproved Category 1 and Category 2 Accredited Activities listed on the QI&CPD Program activities list for practice nurses and practice managers that focus on clinical and nonclinical topics. Practice teams are encouraged to undertake CPR training as a group.

Education providers

Organisations and individuals who provide education to GPs and who want their activities to be recognised and accredited by the RACGP are required to submit applications to their state faculty QI&CPD unit for assessment against the ethical, clinical and educational standards required by the RACGP. Alternatively, education providers can undertake training that allows them to become Accredited Activity Providers for Category 1 and Category 2 or for Category 2 Accredited Activities only, depending on their level of training

http://www.racgp.org.au/rural/traininggrants


and assessment. Once education providers successfully complete the training and assessment process they can Accredit their education activities against QI&CPD Program standards and criteria and use the activity notification system.

All education providers recognised within the QI&CPD Program are required to participate in the continuing quality assurance assessment process. Staff members of the QI&CPD Program undertake regular and ongoing random quality assurance assessments of Accredited Activities to monitor compliance with the ethical, clinical and educational standards in line with the overall objectives of the QI&CPD Program.

The RACGP welcomes and encourages feedback from participants regarding the quality and conduct of accredited QI&CPD Program activities. Education providers are required to make available GP Feedback Forms to all participating GPs.

Sponsorship guidance for all activities

An ethical relationship with sponsoring organisations in relation to the delivery of education to healthcare professionals is essential. The primary purpose of Accredited Activities is to improve the quality of patient care. The educational material covered within the Accredited Activity must meet or exceed the highest clinical and ethical standards, and the aims and outcomes of the QI&CPD Program.

The education content being delivered to GPs must be developed completely independently of input from any sponsoring organisation and from any brief to the facilitator/speaker/writer as to the education materials that should be delivered, covered, revised and/or edited.

Providers must be transparent regarding sponsorship arrangements and must declare how and by whom an Accredited Activity is sponsored each time that Accredited Activity is promoted, advertised or delivered. Speakers are also required to make their own conflict declaration regarding whether they are being paid or receiving other benefits or inducements from a sponsor prior to the relevant Accredited Activity being delivered.

The QI&CPD Program will not accredit an educational activity if there is input from any sponsor(s) to the design, development, education content or delivery of the educational activity. The RACGP considers such input amounts to be a conflict of interest and a breach of the Provider Agreement.

In addition, and in particular, Accredited Activities must not at any stage, either directly or indirectly, promote:

• particular products by use of their brand or trade names – generic (see below for use of generic names) or chemical names must be used on all occasions, unless it is imperative that a branded product be named for a specific contextual reason. Should this be the case, the product must be named once only and all other products in the same drug class must also be named and given equal prominence

• products or modes of treatment disproportionate to their normal contribution to good quality patient care

• products or methods of treatment not in accordance with accepted management standards, or that are balanced by other opinions in areas of clinical practice where accepted management standards are not developed

• experimental treatments and methods that have not been fully evaluated by intervention research

• experimental treatments that do not have the support of the medical profession by reason of inconclusive evidence of therapeutic benefits

• theories and methods of treatment that are not supported by scientific evidence

• techniques that are not accepted by a significant proportion of the medical profession, or that are not supported by accepted medical theory

• therapeutic goods that are not authorised by the Therapeutic Goods Administration for use in Australia

• conflicts of interest that have a perceived adverse effect on the educational quality.


How are points allocated to GP credit point statement records?

In the 2014–16 triennium, there are a number of mechanisms for point allocation for education activities.

GP self directed learning

Category 1 ActivitiesGPs may complete an individual application for Category 1 activities. Individual applications are submitted to the RACGP for adjudication and are subject to Quality Assurance assessments.

Category 2 unaccredited activitiesIndividual GPs may record participation in educational activities that are not accredited by the QI&CPD Program, which they view as valuable to their learning needs. For more information on the recording framework refer to page 47.

Provider activitiesIf a GP attends an RACGP Accredited Activity, the provider will notify the RACGP and points will be allocated to the GP’s QI&CPD Program record. The provider should also forward a certificate of attendance to the GP upon completion of the activity.


GPs with specific requirements

Joint consultative committees and specific requirement groups

The joint consultative committees are tripartite committees that include representation by the relevant specialist college, the RACGP and the Australian College of Rural and Remote Medicine.

Many GPs have requirements for other colleges or similar groups to maintain recognition of particular skills or qualifications. These requirements are often negotiated between the RACGP and other colleges, eg. recertification as a Diplomate of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (DRANZCOG) and reaccreditation as a rural GP anaesthetist.

The RACGP aims to negotiate manageable requirements that ensure appropriate standards and that GPs can meet from several bodies without difficulty. All approved activities in specific requirement areas are integrated with QI&CPD Program requirements and are not in addition.

The QI&CPD Program records a summary of CPD points gained by GPs on credit point statements in the following specific requirement areas:

• diagnostic radiology

• mental health

• medical acupuncture

• women’s reproductive health

• anaesthesia

• surgery.

With the exception of the following specific requirement categories – cultural awareness, mental health CEM, mental health CM, and mental health CPD – category 2 activities do not meet Specific Requirements criteria. Category 2 activities will be for CPD purposes only.


QI&CPD Program development

Each year the RACGP continues to invest in the development of the QI&CPD Program delivered to over 28 000 GPs across Australia. The administrative tasks of the program are more complex and extensive than simply collecting activity attendance data related to the allocation and recording of CPD points for the production of GP credit point statements. The RACGP QI&CPD Program team undertakes to:

• develop standards and criteria for education providers to ensure that GPs have access to high quality educational activities

• advocacy for CPD on behalf of Australian GPs and the profession

• providing advice and training to educational providers on how to improve aspects of their educational activities in order to ensure ongoing quality to GPs

• provide access to high quality educational activities nationally and within state faculties, addressing the diverse interests of Australian general practice and GPs, to ensure a wide choice of activities is available

• monitor the quality of education provided via the quality assurance assessment process

• engage the profession in the design, delivery and review of the program and individual Accredited Activities through a peer review process

• develop and implement a range of quality learning tools and modules to assist GPs in the learning style(s) best suiting their needs

• maintain an accurate and current database of participating GPs, including updating changes of status and address, recording periods of ‘inactivity’ in relation to Medicare Australia recognition status, and providing CPD exemptions for these periods. In these and similar cases, additional flexibility for participating GPs contributes to extra administrative complexity and costs

• provide advice and information to participating GPs through the development and production of the handbook and other resource materials including online tools

• provide credit point statements to GPs, including the administration of other professional development needs for those GPs who have requirements in specific topic areas of general practice

• provide newsletters and information sessions with detailed individual advice to GPs, including written and telephone correspondence

• provide GP resource materials including articles in medical journals and detailed CPD calendars

• update and maintain the QI&CPD Program online system, including immediate access to credit point statement data and resources

• adjudicate individual CPD applications for point allocation

• implement projects to evaluate the QI&CPD Program for ongoing and continuous improvement

• automating provision to all participants of the RACGP QI&CPD Program of Fridayfacts, providing details of the latest emergency health alerts and information relevant to general practice and GPs.

All GPs who participate in the QI&CPD Program are required to pay the annual fee. Members of the RACGP contribute toward the cost of conducting the QI&CPD Program through their membership subscription fees each year, while nonmembers of the RACGP pay an annual administration fee.


Maintenance of GP records of participation

The RACGP maintains a confidential record of each GP’s participation in educational activities in accordance with privacy legislation. Organisers of Accredited Activities agree to provide the QI&CPD Program with a list of participants within 1 month of the activity being completed to ensure that all GPs receive their CPD point allocations. GPs must provide the organiser with their correct RACGP reference number each time they attend an approved activity, otherwise CPD points cannot be allocated to the GP’s QI&CPD Program record.

Education providers are also required to provide GPs with a certificate of attendance at all approved education activities upon completion of the activity. This is to ensure that any discrepancy that may arise with program records can be resolved efficiently.

Privacy and patient confidentiality

GPs are reminded that their relationship with their patients is categorised by law as a relationship of trust and confidence. Patients are entitled to claim privilege in relation to their treatment and to insist upon maintenance of its confidentiality. It is simply not the right of a GP to use such information without the patient’s consent.

When a GP collects patient health information for quality improvement or professional development activities, they may only transfer identified patient health information to a third party once informed patient consent has been obtained.

When a GP is using de-identified patient health information for research purposes, there are some situations in which they are required to obtain informed patient consent and some situations where informed patient consent is not required. The requirement for consent when using de-identified data will be decided by a Human Research Ethics Committee. 14

For a quality improvement activity undertaken within a general practice, where the primary purpose is to monitor, evaluate or improve the quality of healthcare delivered by the practice, ethics approval is not required. 14

Clinical audits or PDSA cycles undertaken within a general practice as part of a quality improvement activity do not require ethics approval. For example, a practice wishing to determine how many of its pregnant patients are given advice on smoking cessation, or how many patients with heart failure are prescribed ACE inhibitors and beta blockers, may complete an audit on their practice data. 14

In general, a practice’s quality improvement or clinical audit activities for the purpose of seeking to improve the delivery of a particular treatment or service would be considered a directly related secondary purpose for information use or disclosure. In other words, in general, the practice would not need to seek specific consent for this use of patients’ health information.14

To ensure patients understand and have reasonable expectations of quality improvement activities, practices are encouraged to include information about quality improvement activities and clinical audits in the practice policy on managing health information. Systems should be implemented to ensure that the patient consents to the use of information and only in a format that will not involve direct or indirect identification of the patient.14

For more information visit www.oaic.gov.au.

http://www.oaic.gov.au.


References

1. Reason J. Human error: models and management. BMJ 2000;320:768–70.

2. Reason J. Beyond the organisational accident: the need for ‘error wisdom’ on the frontline. BMJ 2004;13:28–33.

3. Vincent C. Patient safety. London: Elsevier Churchill Livingstone, 2006.

4. Geboers H, van der Horst M, Mokkink H, et al. Setting up improvement projects in small scale primary care practices: feasibility of a model for continuous quality improvement. Qual Health Care 1999;8:36–42.

5. Cantillon P, Jones R. Does continuing medical education in general practice make a difference? BMJ 1999;318:1276–9.

6. Phillips R, Glasziou P. What makes evidence based journal clubs succeed? Evid Based Med 2004;2:36–7.

7. Linzer M. The journal club and medical education: over one hundred years of unrecorded history. Postgrad Med J 1987;63:475–8.

8. Kleinpell R. Rediscovering the value of the journal club. Am J Crit Care 2002;11:412.

9. Lowe M, Hayhow B. Beyond critical appraisal. Australian Prescriber 2006;29:122–4.

10. Higgs J, Burn A, Jones M. Integrating clinical reasoning and evidence based practice. American Association of Critical Care Nursing Clinical Issues 2001;12:482–90.

11. Ingham G. AGPT Curriculum Framework for General Practice Supervisors. Available at VIC Felix RTP website [Accessed March 2009].

12. The RACGP Curriculum for Australian General Practice, “Teaching, mentoring and leadership in general practice” Melbourne: The RACGP, 2011.

13. American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care circulation. Available at circ.ahajournals.org./cgi/content/full/112/24_suppl/IV-1.

14. The Royal Australian College of General Practitioners. Standards for general practices. 4th edn. Melbourne: The RACGP, 2010.

Healthy Profession.Healthy Australia.

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