ESDGP - Research & Education, Eastern Sydney Division of General Practice, ESDGP

Recognition of the commitment to achieving high quality clinical practice involves the education of medical students beyond their initial training. This now leads to a clinical qualification in General Practice (FRACGP), as well as assisting in the maintenance of professional competence by participation in the QA & CPD Program.

1. To support undergraduate medical education in General Practice

= supporting GPs in teaching undergraduate medical students

The principles of adult learning have been applied to the process of introducing new methods of learning and assessment, centred on problem-based learning in general practice. The principles of adult learning require that this learning:

is perceived as relevant;
is based on and builds on students previous experiences;
is participatory and actively involves students;
is focused on problems;
is designed so that students can take responsibility for their own learning;
can be immediately applied in practice;
involves cycles of action and reflection; and
is based on mutual respect and trust.

The ESDGP has 8 practices providing onsite clinical teaching for undergraduate medical students of the University of NSW & The University of Sydney and 3 practices providing clinical teaching to undergraduate medical students at the Central Clinical School.

2. To support vocational training in General Practice

= supporting GP Supervisors in teaching GP Registrars)

Liaison with GP vocational training providers especially our local consortium, the Sydney Institute of General Practice Education & Training (SIGPET) to ensure involvement of the Division in the educational services provided to GP Registrars and to foster vertical and horizontal integration of general practice education and training, during and after vocational training.

The ESDGP has 3 practices providing vocational training to medical graduates from the Sydney institute of General Practice (SIGPET).

The ESDGP is able to:

Offer GP registrars who are trained with SIGPET in the ESDGP area, membership or associate membership of your Division for the duration of their training.
Send welcome material to each new GP registrar member outlining the services. QA and PD and other opportunities offered by the Division.
Provide details to individual GP registrars and to SIGPET about planned educational activities within the Division, particularly targeting areas of relevance to GP registrars. We are hoping that the Division will also be receptive to GP registrars from other areas within SIGPET attending targeted relevant activities should numbers and logistics allow.
Arrange a visit by a Division Liaison Officer (or specifically allocated Project Officer) to introduce each GP registrar members to the Division, and inform them of the role, structure and activities of the Division in supporting general practitioners within the area.
Allow GP registrar members to attend all Division education activities, some of which may be accredited to the SIGPET training curriculum where appropriate.

3. To support continuing medical education delivery by GPs to Gps

= supporting GPs in teaching GP peers

GPs are encouraged to participate in the planning, facilitation and chairing of clinical meetings; in the preparation and presentation of clinical cases and as speakers.

The Future

The Division is committed to introducing and assisting with the following:

The planning and implementation of a vertically integrated education continuum with the universities, clinical schools, RACGP and general practitioners;
Teach-the-teacher workshops to provide education and training for general practitioners and Division staff to develop teaching skills;
Facilitating the development of, and the further enhancement of, teaching practices, with a core group accredited for both vocational (registrar) and undergraduate teaching; (currently x 1)
Facilitating the development of and the further enhancement of hospital-based teaching, focused on general practice teaching;
To ensure the training arrangements focus on supporting the needs and requirements not only of undergraduate medical students and GP registrars, but GP teachers (GP Supervisors and Clinical Associates).

Representation:
- South East Sydney Academic General Practice Committee (UNSW)
- Discipline of General Practice, The University of Sydney (informal)
- Sydney Institute of General Practice Education & Training (SIGPET)
- Building research capacity in General Practice

Building research capacity in General Practice

1. To forge links with and liaise with GP research providers

The Division needs to foster integration of electronic medical records and electronic decision-making systems into general practice and to involve GPs in population health (and health promotion).

The Division is committed to ensuring whenever possible that members are have been introduced to the principles that will lead to their effective practice of population health, through practicing:

the critical appraisal of health information and in solving population health problems;
communication which facilitates effective interdisciplinary work, collaboration with different sectors and with the community in solving public health problems; and
the introduction of quantitative and qualitative methods of population health research into general practice and evaluation of population health interventions (that is, taking it beyond the basic step of clinical audit).

2. To shift the balance from the medical approach to health promotion to the population approach to health promotion.

In supporting those initiatives aimed at improving the linkages between general practice and population health we can and must examine new directions to ensure adequate incorporation of both population health and primary care perspectives without losing sight of the fact that the health needs of a population, rather than those of the individual patient, is one of the cardinal features of population health.

The ESDGP needs to continue include active participation in program building and population health, including health promotion and preventive care activities.

2a. Program building

The federally funded NSW Primary Health Care Research Capacity Building Program is developing a capacity in primary healthcare in NSW to conduct and use the results of research and evaluation, with particular reference to general practice.

The collaborative parties are the Departments of General Practice and Rural Health at the Universities of Sydney, Newcastle and New South Wales.

By embedding research into general practice we can:

Translate research results into clinical practice (that is, to use the results of research in general practice eg. guidelines and evidence-based medicine (EBM) activities); and
Undertake research as part of clinical practice (that is, to participate in clinical audits or investigator-led research).

The capacity building approach is a useful approach for general practice, providing a framework where universities can provide education and technical support, building on and retaining the systems and structures of general practitioners and Divisions of General Practice.

2b. Population Health

The Australian health system has focused almost exclusively on disease treatment. To state what now seems obvious, primary health care involves a balance between health promotion, disease prevention and disease treatment.

However, to shift the balance requires fundamental changes in orientation and thinking about health.

General practitioners have played an integral role in the wider health care system and as such have been and are strategically placed to contribute to population health. At various levels we have already participated in a number of strategies aimed at strengthening national approaches to population health:

the National Drug Strategies;
the National Better Health program;
the National HIV/AIDS Strategies;
BreastScreen Australia; and
the National Cervical Screening Program.

Population health activities can be broadly categorised as health promotion and preventive care.

The ESDGP is committed to participating in the development and implementation of health promotion activities and preventive care activities, which general practitioners can offer to their patients.

2b(i). Health Promotion Activities

Health promotion is defined as the process of enabling people to increase control over and improve their health. It involves the population as a whole in the context of their everyday lives, rather than focusing on people at risk for specific diseases.

That is, the population health approach to health promotion

Eg.Ten Point Nutritional Guidelines for Childhood and Adolescent Nutrition

General practitioners are ideally placed to take responsibility for population health initiatives. The provision of nutritional advice for children and adolescents is one such initiative. Such an expanded role for general practitioners in population health requires the availability of useable and evidence-based guidelines and effective promotional strategies. The aforementioned guidelines provide one such tool for this process.

2b (ii). Preventive Care Activities

Preventive care covers a wide range of activities traditionally divided into:

primary prevention which maintains health by removing or preventing the precipitants of ill health, for example through measures such as immunisation,
secondary prevention which reduces the prevalence of disease and disability through the early detection of diseases, and
tertiary prevention, which aims to prevent the onset of deterioration and complications when disease or disability are already established.

Eg. HPV Detection in the Management of Screen Detected Cervical Abnormalities

General practitioners are suitably placed to provide preventive strategies to patients. The provision of guidelines for the management of cervical screening detected abnormalities requires the availability of useable and evidence-based guidelines and effective promotional strategies.

The aforementioned preventive approach provides a basis for the further refinement of the existing guidelines for use in general practice.

3. To support project/grant applications

The provision preliminary evaluation, guidance and appraisal of project and/or research application submitted to by the Division.
Eg. Quality Use of Medicines - Hypertension

The Future

Australasian Cochrane Centre - electronic decision support
Better Outcomes in Mental Health Care in General Practice
Impaired Glucose Tolerance in General Practice

Representation

Australian Association of Academic General Practitioners
Australian Centre for Diabetes Strategies

Conferences

National = PHCRIS = General Practice & Primary Health Care Research Conference
State = NSW Primary Health Care Research Capacity Building Program
For further information contact Professor Eugen Molodysky at the Division

Research Education

Building research capacity in General Practice

Links

Research Projects

Contact details of local Human Ethics Committees