AUGUST 2013 - New Zealand Doctor

RNZCGP Review of the delivery of general practice vocational training August 2013Option 4.1 (status quo): No compulsory placementIn the current model of registrar placement, registrars are offered placements in practices thatare located within the region that they requested on their application form. Where there are noplacements within the preferred region, the registrar is given the option to accept a placement inother regions, but this is at their discretion.The College works with practices in rural and high needs areas to ensure that these practices arewell represented in the pool of possible placements.Option 4.2: One compulsory placementThis option would involve registrars being required to undertake at least one placement during theirtraining in either a high needs, a rural or a Māori/Pacific Island placement. Within each region thereare practices which would meet one of these three categories.Compulsory training requirements are often difficult to manage for registrars, practices and theCollege and carry with them the risk of dis-incentivising participation and completion of the GPEPprogramme.Option 4.3: Clustered practicesAt present, registrars are placed in geographically spread practices, with the only commonrelationship being regional seminar location. An alternative would be to ensure there were a numberof practices within a reasonably close geographical distance and registrar placements would bemade within this cluster.This would provide an educational community with teachers and registrars working in close proximitywhich supported the small group learning model and enabled registrars to move between practicesto gain a variety of experiences. This model currently exists in the smaller regions throughout NewZealand.Option 4.4: Imposing minimum numbers of registrars per region andrestricting training to regions with five or more registrarsThere is the option of imposing a target of a minimum number of registrars that must be reachedbefore training is delivered in a region, thereby reducing ME costs per registrar in smaller regions.Currently ME costs per registrar range between $7,000 in regions with high registrar numbers, to$24,000 in three regions where there are less than five registrars. There is concern about providingvariety and completing the required educational tasks when the group is less than four. However, thisneeds to be balanced against the need to have registrars training in hard to staff regions and thosewith high patient to GP ratios.This option would offer GPEP training only in those regions that have five or more registrars. Whilereducing costs of training, this option could have a negative impact on supporting the continuingsupply of GPs within rural and/or smaller regions. Additional regions with low numbers of registrarsare often regions with low numbers of GPs.Option 4.5: For regions with less than five registrars, a virtual learningcluster is createdAn option exists, for regions with fewer than five registrars, to create a virtual learning cluster, in whichthe registrars learn through internet conversations via Skype or similar. Although these registrarswould be located in different geographic regions, the difficulties they face as isolated GP registrarswould be similar. This option would reduce the number of ME tenths employed by the College,however there would be costs associated with the set-up and running of a virtual learning cluster.31