In-practice and distance consultant on-call general practitioner supervisors for Australian general practice?

Susan M Wearne
Med J Aust 2011; 195 (4): 224-228. || doi: 10.5694/j.1326-5377.2011.tb03288.x
Published online: 15 August 2011

Educational initiatives designed to meet Australia’s future medical workforce requirements have increased the number of medical students and junior doctors in general practice, especially in rural areas. General practitioners understand the rationale for these initiatives, and many welcome the new opportunities,1 but it is unrealistic to expect GPs to cope with the large-scale changes involved without addressing the impact of the changes on GPs’ core role and source of income — patient care. Each initiative can seem small, but as all share the same resource — general practice and GPs — their combined impact is substantial. Large-scale change, arising from multiple smaller programs, requires support and consideration of the impact of the changes on current work practices. The potential crisis in GP teaching creates an imperative for innovations that increase capacity without reducing the quality of patient care or training.2

This article outlines the current framework of general practice education within Australia and argues why this is an insufficient model for the demands now being placed on it. One alternative model for facilitating learning in general practice is suggested for implementation and evaluation.

New on-site programs

Various programs to place learners in general practice have been created (eg, the Prevocational General Practice Placements Program).4-9 Each learner comes to general practice with an expectation of direct patient contact but with different skills and experience. Institutional support for GP supervisors varies — from paperwork and the offer of honorary academic posts to practice grants and paid teaching time. There is limited correlation between the amount of support offered to the supervisor and the educational needs of the learner.

New off-site programs

Initial trials of distance supervision10 have been consolidated by the Remote Vocational Training Scheme,11 and off-site supervision occurs for doctors registered under area-of-need provisions12 and in the ACRRM Independent Pathway.13 Distance supervision injects experience into isolated areas, but also creates more demand on busy GP supervisors and requires reliable equipment and connections, as well as effort to engage learners.14

Criticisms of the current educational programs in general practice (Box 1)
Reactive supervision versus time for proactive supervision and teaching

While responding to queries is a challenge, it identifies that the learner is aware of his or her limits. Of more concern is the poorly performing learner with limited insight20 or inaccurate self-assessment skills.21 Supervisors need time to directly observe learners, and finding learners’ blind spots has been a particular challenge for distance supervisors22 that webcams are now helping to overcome.23

Last-minute arrangements for supervision

Area-of-need legislation12 permits doctors to work as GPs before qualifying as GPs providing they work towards gaining GP qualifications and have an on-site or distance supervisor. These doctors and their supervisors are not supported by or subject to the standards of the Australian General Practice Training program. Recruitment agencies work hard to fill health workforce gaps, but there are anecdotal reports that the employment arrangements are made well in advance of the supervision arrangements. GPs who are asked to be supervisors “at the last minute” feel torn between agreeing to supervise someone whose skills and experience they have not assessed for the needs of the proposed clinical role, and saying no and facing the ire of recruiters, the doctor and the community.

Distant and local consultant on-call GP supervisors — a new model

An alternative model of consultant on-call GP supervisors (CoGs) could coordinate education and training within a practice team as well as supervise senior general practice registrars at a distance (Box 2). This would overcome many of the problems cited above and provide much-needed additional training capacity. CoGs would be freed from their own clinical load and their prime responsibility would be proactive and reactive facilitation of junior doctors’ work-based learning. Most of the on-call work would be during the day, when general practices are open. Options for night cover would include reverting to current arrangements or having a reduced number of CoGs supporting a larger number of juniors.

CoGs would enact Kilminster and Jolly’s definition of clinical supervision:

CoGs would need to be expert clinicians. They would be accredited through the same mechanism as that used for GP supervisors and would require training in teaching and supervisory skills. GPs recognise the benefit of teacher training,26,27 but have cited the need for dedicated time and financial support to study.28 CoGs would maintain currency and credibility as GPs by doing part-time clinical work.

CoGs would be involved in recruiting and placing potential trainee doctors, planning practice-based teaching, actively monitoring the quality of patient care and seeking doctors’ blind spots (eg, by audit or video observation). CoGs would support juniors faced with an on-site medical emergency, but responding to off-site emergencies would be limited to advice only. Good emergency skills would be a prerequisite for a doctor under distance supervision. Using fair and transparent systems, CoGs would collate feedback from the health care team and patients about learners and would encourage direct informal communication and learning among team members. CoGs would liaise with learners, educational institutions, colleges and employers, and learners would understand the rationale that this was best for patient safety and their long-term career.

Patients would be reassured that seeing the junior in a practice was a safe option, and the CoG’s involvement might help to preserve continuity of care.29 The CoG model could provide senior doctors with the flexibility and career progression needed to sustain them in the workforce30 and prevent their early retirement and loss of their wisdom from general practice. The CoG role might rotate between senior doctors in one practice or across practices in a town or region. In a rotating system, one CoG would be designated as a learner’s main supervisor/mentor.

Funding and resources

Funding this model will require resources from the education and workforce sectors and is a potential sticking point, but without extra resources the investment in medical school places and junior doctor programs is a potential waste. Educational funding should flow to the site of the education — general practice.

The salary for CoGs should be set at the GP consultant level. The MABEL (Medicine in Australia: Balancing Employment and Life) survey showed that average earnings were $316 750 for specialists and $177 883 for GPs in 2008.31 A salary set at $250 000 for CoGs would recognise the consultant nature of the role as well as covering some practice overheads, but it would still be lower than the average salary earned by procedural rural GPs. Assuming each CoG supervised four learners, the cost of providing the 76 000 training weeks that were required in 201032 would be $91 million. Although this sounds exorbitant, it reflects part of the true cost of quality supervision in general practice. This amount is still less than the over $100 million required for the Australian General Practice Training program.

Should funding be redirected into general practice from program administrative and governance costs? The ideas of Thistlethwaite and colleagues30 on pooling separate funding streams provide a sound basis on which to begin some difficult yet important discussions about funding for CoGs and provision of information technology, training and infrastructure support.


A model of consultant on-call GP supervisors and an expansion of distance supervision of senior general practice registrars could address many of the issues facing general practice education. Funding, information technology and detailed evaluation of this innovation would be needed to test its ability to provide effective educational supervision and quality patient care. Australia’s investment in increased medical student places will be an expensive folly unless general practice teachers are supported.

2 Future model of teaching in general practice


Main function




GP = general practitioner. CoG = consultant on-call GP supervisor.

Provenance: Not commissioned; externally peer reviewed.

  • Susan M Wearne1

  • Rural Clinical School, Flinders University, Alice Springs, NT.


I would like to thank Nina Kilfoyle, Jenny May, Louise Stone and Tim Skinner for comments on earlier drafts of my article. The article does not necessarily reflect their opinions or those of other past or current colleagues and employers.

Competing interests:

I am a GP trainer for Northern Territory General Practice Education and a preceptor for Flinders University medical students in general practice. I am a teacher for the Flinders University Master of Clinical Education course and have been a medical educator and supervisor for the Remote Vocational Training Scheme.

  • 1. Larsen K, Perkins D. Training doctors in general practices: a review of the literature. Aust J Rural Health 2006; 14: 173-177.
  • 2. National Health Workforce Taskforce. Health workforce in Australia and factors for current shortages: April 2009. %20and%20factors%20influencing%20current%20shortages.pdf (accessed May 2011).
  • 3. Trumble SC. Changes to training for general practice in Australia. Asia Pac Fam Med 2003; 2: 171-174.
  • 4. Australian Department of Health and Ageing. Students/trainees. Rural clinical schools. (accessed May 2011).
  • 5. Australian College of Rural and Remote Medicine. John Flynn Placement Program. About the program. (accessed May 2011).
  • 6. Worley PS, Esterman A, Prideaux DJ. Cohort study of examination performance of undergraduate medical students learning in community settings. BMJ 2004; 328: 207-209.
  • 7. Mugford B, Martin A. Rural rotations for interns: a demonstration programme in South Australia. Aust J Rural Health 2001; 9 Suppl 1: S27-S31.
  • 8. Australian General Practice Training. Prevocational General Practice Placements Program (PGPPP). (accessed May 2011).
  • 9. Australian General Practice Training. Australian General Practice Training handbook 2011. Canberra: General Practice Education and Training Limited, 2010. (accessed May 2011).
  • 10. Hays RB, Peterson L. Options in education for advanced trainees in isolated general practice. Aust Fam Physician 1996; 25: 362-366.
  • 11. Wearne S, Giddings P, McLaren J, Gargan C. Where are they now? The career paths of the Remote Vocational Training Scheme registrars. Aust Fam Physician 2010; 39: 53-56.
  • 12. Medical Board of Australia. Area of need. (accessed May 2011).
  • 13. Australian College of Rural and Remote Medicine. Standards: supervisors and teaching posts in primary rural and remote training. (accessed May 2011).
  • 14. Sargeant JM. Medical education for rural areas: opportunities and challenges for information and communications technologies. J Postgrad Med 2005; 51: 301-307.
  • 15. Laurence C, Black L, Karnon J, Briggs N. To teach or not to teach? A cost–benefit analysis of teaching in private general practice. Med J Aust 2010; 193: 608-613. <MJA full text>
  • 16. Walters L, Worley P, Prideaux D, Lange K. Do consultations in rural general practice take more time when practitioners are precepting medical students? Med Educ 2008; 42: 69-73.
  • 17. Cantillon P, Sargeant JM. Giving feedback in clinical settings. BMJ 2008; 337: 1292-1294.
  • 18. Stewart J. To call or not to call: a judgement of risk by pre-registration house officers. Med Educ 2008; 42: 938-944.
  • 19. Accreditation Council for Graduate Medical Education. Family Medicine Program requirements. (accessed May 2011).
  • 20. Hays RB, Jolly BC, Caldon LJ, et al. Is insight important? measuring capacity to change performance. Med Educ 2002; 36: 965-971.
  • 21. Langendyk V. Not knowing that they do not know: self-assessment accuracy of third-year medical students. Med Educ 2006; 40: 173-179.
  • 22. Wearne S. General practice supervision at a distance — is it remotely possible? Aust Fam Physician 2005; 34 Suppl 1: 31-33.
  • 23. Cooling N. The use of web-cams for ECT visits. General Practice Education and Training Convention; 2008 Aug 27-28; Wollongong, Australia.
  • 24. Australian College of Rural and Remote Medicine. Assessment handbook for fellowship training. Brisbane: ACRRM, 2010: 9.
  • 25. Kilminster SM, Jolly BC. Effective supervision in clinical practice settings: a literature review. Med Educ 2000; 34: 827-840.
  • 26. Molodysky E, Sekelja N, Lee C. Identifying and training effective clinical teachers— new directions in clinical teacher training. Aust Fam Physician 2006; 35: 53-55.
  • 27. Wearne S, Giles S, Hope A. Barriers and enablers for implementing general practice training. Aust Fam Physician 2004; 33: 182-184.
  • 28. Waters M, Wall D. Educational CPD: how UK GP trainers develop themselves as teachers. Med Teach 2007; 29: e160-e169.
  • 29. Bonney A, Phillipson L, Reis S, et al. Patients’ attitudes to general practice registrars: a review of the literature. Educ Prim Care 2009; 20: 371-378.
  • 30. Thistlethwaite JE, Leeder SR, Kidd MR, Shaw T. Addressing general practice workforce shortages: policy options. Med J Aust 2008; 189: 118-121. <MJA full text>
  • 31. Cheng T, Scott A, Jeon S, et al. What factors influence the earnings of GPs and medical specialists in Australia? Evidence from the MABEL survey. Melbourne: University of Melbourne, 2010. (Melbourne Institute Working Paper Series No. 12/10.) (accessed May 2011).
  • 32. Australian General Practice Training. GPET annual report to 30 June 2010. Canberra: General Practice Education and Training Limited, 2010. (accessed May 2011).


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