General Practice A lifelong learning journey

11 August 2017                     
Dr Ayman Shenouda
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Developing a skill set around your community’s needs.

Just like lifelong learning, community needs assessment is a continual process that helps us to ensure our community has the best possible service mix. Health needs assessment is developmental and has to be added to or adjusted over time as the community’s needs change. It is alongside that process that we commit to continual learning, to adjust our skills over time to ensure these needs are met.
 
For a rural community, where resources and infrastructure are scarce, needs assessment is a critical process. It helps you to prioritise where you can make the biggest impact, to plan and deliver the most effective care against those areas of critical need. It enables you to work collaboratively with the local community to develop the infrastructure required. Most of all it becomes a partnership as people centred health relies on community participation and through this process, you find yourself fully immersed in community life.
 
My journey
 
When I arrived in Wagga Wagga 17 years ago, I was armed with some advanced surgical skills acquired while working as a surgical registrar in Egypt, then further honed in Tasmania during my initial few years in Australia. Naturally, my fellow GPs in the practice referred to me patients with surgical skin conditions.  This was great as it allowed me to utilise my skills, on the other hand, though patient expectations increased as they were under the impression that I was a Dermatologist!
 
In all honesty, my dermatology skills weren’t all that flash and it was clear the local service gap in Dermatology needed fixing. I subsequently completed a Diploma of Dermatology in 2003 through the University of Wales in Cardiff. I became very popular and started to have referrals from other practices in town, as without a local area specialist that role continued to fall to me. It was out of unmet need that this became a necessity of course but it really was the community driving that decision to upskill.
 
Now the Wagga community has access to dermatology services I am adjusting again but to a new requirement in palliative care. This is demonstrative of lifelong learning in practice – The good GP never stops learning – in providing lifelong care there relies a commitment to lifelong learning to adapting your skills to meet changing needs.
 
For those looking for more inspiration, there were some great rural stories produced some years ago. During 2012, the RACGP rural faculty celebrated its 20th anniversary and as part of our commemorating that milestone we produced a series of inspiring stories “Getting to know our rural GPs”. These stories were truly demonstrative of just how diverse the profession is and the depth of skills needed in supporting the often-complex needs of rural communities, while also highlighting the unique nature and rewards of living and working in rural general practice.
 
Applying a lifelong learning framework
 
In applying a lifelong learning framework, we already have the key structures to facilitate this. The Fellowship of the Royal Australian College of General Practitioners (FRACGP) signifies that a GP has been assessed as competent across the core skills of general practice enabling him or her to practice safely, unsupervised, anywhere in Australia.
 
The FARGP is a qualification awarded by the RACGP in addition to the vocational Fellowship (FRACGP). Providing a dedicated pathway for both general practice registrars and experienced practising GPs, the FARGP aims to develop advanced rural skills and broaden options for safe, accessible and comprehensive care for Australia’s rural, remote and very remote communities.
 
The FARGP is unique here in terms of using a population health approach to plan and execute health service needs for a community. The community-focussed project is undertaken over a six-month period and enables you to get to know your community and engage with them to improve health. This important requirement equips the candidate with essential planning tools and establishes leadership in a community.
 
Skill development in policy
 
For trainees, key to ensuring broad skill exposure is the need to map the training process to ensure a wide variety of experiences can be provided. Needs analysis is again critical here and this level of planning is something we should be doing more of at both the state and national levels. This level of planning provides a comprehensive training program and a way to ensure skills learned are transferrable to their practice after the completion of training posts in building a resilient workforce.
 
After all, it is these trainees that will provide vital services in the future. Ensuring broad exposure and allocating placements according to specific learning needs and against community need at this early stage makes perfect sense in planning a future generalist workforce. The new regional training hubs should help to support this needs assessment to tailor a training package which provides for the level of flexibility required to truly immerse in the community as well as ensure relevant clinical exposure.
 
Just as vital is the requirement for a skill-acquisition pathway for practising rural GPs acknowledging the lifelong learning requirement and addressing unmet need. A stronger focus is required at both the state and national levels in terms of providing that structure or mechanism in the current arrangements to facilitate training for those who wish to go back and retrain to meet a skill need in their community.
 
The Commonwealth’s Rural Procedural Grants Program is vital in supporting skill maintenance in some key hospital-based skill areas. Applying a population health needs assessment in terms of skill acquisition requirements should guide decisions at the policy level. This process would see an expansion of the procedural grants program to include essential non-procedural advanced skills. Policy planning needs to factor and be responsive to current and future need just as the GP does in responding to the changing health needs of their community over a lifetime.
 
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