About the progressive capability profile of the general practitioner

������Ƶ (RACGP) Progressive capability profile of the general practitioner (the Profile) is one of three key educational structures, or ‘guiding instruments’, within the RACGP educational framework. The other two guiding instruments are the RACGP curriculum and syllabus for Australian general practice and RACGP educational policies and standards. The three educational structures are integrated and together inform RACGP education, including learning, training, assessment and performance management.

The Profile details the progressive expansion of competency and scope of practice from commencement of general practice vocational training to the attainment of RACGP Fellowship and the certification for independent practice as a general practitioner (GP) in Australia. Transition into independent practice requires attainment not only of knowledge and skills, but also of professional attitudes and confidence. These professional attitudes have not, until now, been well defined nor formally assessed in Australian general practice training. The Profile addresses this.

The Profile introduces competency milestones matched to a progressive scope of practice. It defines the capabilities and competencies required at four milestones of general practice vocational training, as well as the specific knowledge, skills and attitudes required to attain these competencies. 

The Profile is an important and innovative document that will support education for general practice and provide direction for training and assessment programs. 

The development of the Profile involved consultation with multiple stakeholders, both internal and external to the RACGP. This is a living document that will be reviewed with further consultation as educational imperatives and environments change. It will also have a regular cycle of evaluation and revision, aligned with that of the curriculum and syllabus. 

Dr Tess van Duuren  
RACGP Censor-in-Chief
 &�Բ�����;
Adj Prof Karen Price �į�į
RACGP President 

Paul Wappett 
Chief Executive Officer

Acknowledgement of Country

The RACGP acknowledges Aboriginal and Torres Strait Islander peoples as the Traditional Custodians of the land and sea in which we live and work; we recognise their continuing connection to land, sea and culture, and pay our respects to Elders past, present and future. We also pay our respects to Aboriginal and Torres Strait Islander RACGP staff and general practitioners. The RACGP also acknowledges the wrongs of the past directed toward Aboriginal and Torres Strait Islander peoples and the ongoing intergenerational impacts.

Working towards culturally safe care

The RACGP is committed to inclusivity and celebrating diversity. The Profile aims to ensure that Aboriginal and Torres Strait Islander health and the knowledge, skills and attitudes of a culturally safe approach to primary care form an essential part of learning, training and assessment for all GPs in training.

The capabilities and competencies required to deliver culturally safe and quality care and to work in partnership with Aboriginal and Torres Strait Islander peoples are essential characteristics of an Australian GP. Their attainment should continue to be identified as a priority.

Culturally safe attitudes and behaviours when working with Aboriginal and Torres Strait Islander peoples can only be assessed by Aboriginal and Torres Strait Islander peoples (patients, cultural educators or advisors, or health professionals, where relevant). An individual doctor cannot deem themselves to be culturally safe without appropriate mechanisms in place, nor can they be deemed culturally safe by non-Indigenous peoples or mechanisms. Cultural safety is a continuum and there is no ceiling competency. It requires intellectual humility, reflection and continuing professional and personal development.

This is a part of the RACGP’s ongoing collaboration with Aboriginal and Torres Strait Islander peoples to work towards a healthcare system that is free of racism and where all GPs and practice teams deliver culturally safe care.¹

Project team

• Alanna Kirley, Program Lead
• Maria Humphries, Editor
• Josephine Borthwick, Evaluation Officer

The RACGP and project team gratefully acknowledge the following people, groups and committees that have contributed to the development and review of the Profile.

Principal Medical ������Ƶ Advisor

Assoc Prof James Brown

Steering Committee

Mr Russell Baker Dr Sean Black-Tiong Assoc Prof James Brown Ms Angela Burden Ms Pauline Diano Ms Chris Cook

Dr Judith Culliver Ms Tess Joseph Mr Rob LoPresti Dr Nyoli Valentine Dr Tess Van Duuren

 

Expert Advisory Group

Assoc Prof James Brown Dr Joanna Bruce Dr John Buckley Dr Gary Butler Dr Catherine Casey Dr Judith Culliver Dr Paul Dilena Ms Marlene Drysdale Dr Karin Jodlowski-Tan

Ms Jacqueline Lesage Dr Prasad Kumar Dr Ronald McCoy Dr Olivia O’Donoghue Ms Nicole Quaife Dr Rebecca Stewart Dr Nick Theoharidis Dr Nyoli Valentine

 

Reviewers

RACGP Aboriginal and Torres Strait Islander Health Council  RACGP Aboriginal and Torres Strait Islander Health ������Ƶ Committee  RACGP Business Sustainability Working Group RACGP Continuing Professional Development  RACGP Council of Censors  RACGP ������Ƶ and Strategy Development RACGP National Faculty for GPs in Training RACGP Expert Committee – Funding and Health System Reform RACGP Expert Committee – Practice Technology and Management RACGP Expert Committee – Quality Care RACGP Expert Committee – Research RACGP Expert Committee – Standards for General Practices RACGP Rural Australian Commission on Safety and Quality in Health Care Australian Medical Council Australian National University Rural School Eastern Victoria GP Training  General Practice Medical Educators  General Practice Registrars Association  General Practice Training Queensland General Practice Training Tasmania GP Synergy GPEx Griffith University Indigenous General Practice Registrars Network International Medical Graduate Committee James Cook University General Practice Training  Lead Medical Educator Committee Leaders in Indigenous Medical ������Ƶ Murray City Country Coast GP Training National Aboriginal Community Controlled Health Organisation National Cultural Mentor and Cultural Educator Network  Northern Territory General Practice ������Ƶ  Regional Training Organisations Network Registrars Network Remote Vocational Training Scheme  The University of Melbourne The University of Sydney University of New England University of New South Wales University of Newcastle University of Notre Dame Western Australian General Practice ������Ƶ and Training

Dr Louise Acland Dr Jason Agostino Assoc Prof Lilon Bandler Dr Shayne Bellingham Dr Sean Black-Tiong Dr Rachael Boland Dr Antony Bolton Ms Jasmin Boys Dr Joanna Bruce Dr Danielle Carter Dr Catherine Casey Dr Shanti Caulley Dr Rachel Chen Dr Erica Clarke Dr Lisa Clarke Dr Michael Clements Ms Shanel Cubillo Dr Jenny Davis Ms Daniela Doblanovic Prof Anne Duggan Dr Tess van Duuren Dr Catherine Eltringham Dr George Eskander Assoc Prof Karen Flegg Assoc Prof Lara Fuller Dr Pat Giddings Assoc Prof Lucy Gilkes Dr Katrina Giskes Dr Michelle Guppy Dr Ronda Gurney Dr Ashley Hayes Assoc Prof Charlotte Hespe Ms Kathleen Hickey Assoc Prof Chris Hogan Dr Rob Hosking Dr Duncan Howard Dr Chris Hughes Dr Carolyn Hullick Dr Nicholas Hummel Dr Gerard Ingham

Dr Danielle James Dr Sharmila Jayaram Dr Mark Johnson Ms Tess Joseph Dr Arella Keir Assoc Prof Isobel Kerridge Mr Chris Kyranis Dr Rebecca Lock Mr Rob LoPresti Dr Eldon Lyon Prof Parker Magin Dr Marisa Magiros Dr Ralph Mangohig Assoc Prof Jo-Anne Manski-Nankervis Dr Liz Marles Dr Jenny McConnell Dr Mark Miller Dr Vanessa Moran Assoc Prof Mark Morgan Dr Olivia O'Donoghue Conjoint Prof Di O'Halloran Assoc Prof Peter O'Mara Ms Kim Packham Ms Ada Parry Dr Frances Poliniak Hon Prof Dimity Pond Dr Pieter Pretorius Dr Donna Quinn Assoc Prof Joel Rhee Dr Lara Roeske Prof Gary Rogers Dr Tim Senior Mr Peter Thomsen Dr Edward Vergara Ms Jenny Vibert Ms Chantelle Vonarx Assoc Prof Kylie Vuong Dr Ken Wanguhu Dr Margot Woods Dr Michael Wright

The development of the RACGP Progressive capability profile of the general practitioner was funded by the Australian Government Department of Health. 

������Ƶ (RACGP) Progressive capability profile of the general practitioner (the Profile) is a key structure in RACGP education (Figure 1). It is central to the RACGP educational framework and is based on its guiding principles. It is a public statement of the RACGP’s view of what an Australian general practitioner (GP) is and does. It represents the progressive expansion of competency and scope of practice that occurs over the period of vocational training towards Fellowship, and defines the key milestones in competency development matched to an expanding scope of practice across the training journey.²

This Profile is the product of significant consultation and collaboration. It was developed following an extensive review of existing national and international competency and capability frameworks, and a review of the current literature on best practice approaches to progressive assessment.

The Profile’s structure is based on four identified roles of a GP’s work. This delineation of roles is informed by the new structure of the Australian Medical Council’s (AMC’s) prevocational capability framework.³ The four identified roles are:

1. clinician
2. health advocate and leader
3. ethical professional
4. scholar and scientist.

Fifteen capabilities are defined across the four roles. A capability is a high-level ability to perform the tasks required of a GP. Each capability is linked to competencies that enable the capability. Each competency is then further described by indicative knowledge, skills and attitudes that contribute to that competency.

Four milestones are defined that represent the progressive attainment of capability and competency, and these are matched to a progressive increase in scope of practice. These milestones are based on three key transition points along the training journey that have been identified by research in general practice vocational training:

• entry to general practice
• the transition to indirect supervision
• the transition to independent practice.

The Profile adds a transition point – the transition to ad hoc (or loose) supervision – that occurs late in training and prior to certification for independent practice.

Competencies are distributed across the four milestones of training to indicate by which stage of training the competency should be achieved. This provides guidance and direction for learning, educational delivery and progressive assessment in general practice education across the vocational training journey.⁴
 

Figure 1. The three guiding instruments of the RACGP educational framework, including the Progressive capability profile of the general practitioner, that direct vocational training

Objectives and aims

The objective of the Profile is to provide a representation of the progressive attainment of the capabilities of an Australian GP across the vocational training journey to Fellowship. It seeks to encompass the range of roles, activities and contexts in which Australian GPs train and work.

The Profile aims to provide a guide for:

• future curriculum and syllabus competency frameworks
• educational policies and standards
• learners, education providers, training programs and assessment activities
• identifying gaps in knowledge and skills
• benchmarking professional behaviour
• progress and performance management.

In meeting these aims, the Profile gives both broad and detailed descriptions of the capabilities, knowledge, skills and attitudes required at progressive milestones of vocational training. It has a focus on the safety of patients and registrars and emphasises competencies needed to address health inequities. It specifically articulates the competencies essential for working with Aboriginal and Torres Strait Islander communities to deliver respectful and quality care to Australia’s First Peoples. It includes competencies for providing quality care to individuals and families in rural and remote communities, and to individuals and families from culturally and linguistic diverse backgrounds.

Extended skills and lifelong learning

The Profile presents the progressive expansion of competency and scope of practice that occurs over the period of vocational training towards Fellowship. It currently does not include the attainment of extended skills and knowledge in specific areas of general practice in the years following attainment of Fellowship. Many GPs choose to develop extended skills in areas of specific interest, and/or to meet the particular needs of communities. The development of extended skills may commence prior to, or following, Fellowship. It is intended that future iterations of the Profile will address extended skills in specific areas of interest as part of the career and lifelong learning journey of GPs.

Beyond Fellowship, GPs continue their lifelong learning journey through the lived experience of working in general practice, ongoing professional development, further integration and refinement of the capabilities and competencies defined in the Profile, and, for many, the development of extended skills in response to patient need and/or interest.

There are currently over 30 specific interest areas in which GPs may choose to develop extended capabilities and competencies, such as business management, medical education, sports medicine, sexual health or refugee health, and that may form part of lifelong learning, as required and appropriate to the context of the individual GP’s practice.

Statement of Fellowship outcomes

Not all competencies of the Profile are achieved at the Fellowship milestone; some are achieved at an earlier milestone. The Statement of Fellowship outcomes sits alongside the Profile and provides a list of all the competencies expected to be achieved at the point of Fellowship – it is a statement of all the outcomes of training and the standard expected of a GP practising independently in Australia.

The Profile was developed in consultation and collaboratively with GPs, supervisors, medical educators, cultural educators, GPs in training and consumers. This was achieved through a Steering Committee, an Expert Advisory Group, two think tanks and review by internal and external stakeholders.

The Steering Group provided oversight of the project and ensured that it aligned with RACGP objectives. Its membership included key internal stakeholders.

The Expert Advisory Group provided industry and community sector expertise, advice, review and feedback. Membership included senior medical educators from regional training organisations, supervisors, GPs in training, consumers, cultural educators and RACGP staff from the RACGP National Faculty for GPs in Training, RACGP Assessment Development and Operations, RACGP Rural, RACGP Aboriginal and Torres Strait Islander Health faculty, curriculum review project team, syllabus project team, Council of Censors and RACGP ������Ƶ Strategy and Development.

Two think tanks were held to help determine the objectives of the Profile and its alignment with other educational processes within the RACGP. Governance of the project was monitored by a Steering Committee and the RACGP Portfolio Management Office. 

An extensive literature review was undertaken, including review of validated primary care competency measures at different stages of training, Australian and international capability and competency frameworks and primary care curricula (refer to Bibliography). Mapping was undertaken against these frameworks, the RACGP curriculum and syllabus, and the assessment clinical competency rubric to ensure that there were no gaps in the competencies expressed in the Profile.

A key decision was whether to continue to use the RACGP domains of general practice or a role-based structure to organise the capabilities. This decision was considered at length by both the Expert Advisory Group and the Steering Committee. A role-based structure was chosen as it reflects practice in action and is aligned with the new role-based structure of the AMC prevocational capability framework.

Through continued consultation with the Expert Advisory Group and RACGP national clinical leads, the Profile was revised iteratively before being distributed for broader stakeholder review. Feedback provided was collated and appropriate changes made to finalise the structure and competencies of the Profile. 

The knowledge, skills and attitudes of the Profile have been informed by the learning outcomes of the curriculum and syllabus and provide indicative examples for each competency. These are grouped according to the milestones of training to support progressive learning and assessment.

A change in structure

The structure and nomenclature chosen for the Profile are significantly different from those used in the current and previous versions of the RACGP curriculum and syllabus (Table 1).

The primary categorisation of the Profile is by the roles of a GP rather than by domains of practice. The second category is capabilities rather than core skills or core competencies. The third category is competencies rather than competency outcomes. The fourth is indicative knowledge, skills and attitudes, which are essentially learning outcomes. These replace the previous performance criteria.

The 2022 curriculum and syllabus was developed prior to the Profile. This means that it is not completely aligned and there are significant differences, particularly in the primary category, with the 2022 curriculum and syllabus retaining the domains of general practice. The task of achieving full alignment will be undertaken at the next review of the curriculum and syllabus.

Table 1. Categorisation of the Profile compared to the 2016 curriculum and 2022 curriculum and syllabus
 

Category	The Profile	2016 curriculum	2022 curriculum and syllabus
1	Four roles of the GP	Five domains of general practice	Five domains of general practice
2	15 capabilities	13 core skills	15 core competencies
3	Competencies across four training milestones	Competency outcomes: core rural Aboriginal and Torres Strait Islander health	Core competency outcomes
4	Knowledge skills and attitudes as learning outcomes	Performance criteria across three stages of the GP’s professional life	Learning outcomes

The Statement of Fellowship outcomes outlines the competencies to be expected at the point of Fellowship. As such, it is a statement of all the outcomes of training and is the standard to be expected of a general practitioner practising independently in Australia. As well as being the end point of structured general practice training, it is therefore also the level of competency for all doctors practising as independent GPs. These outcomes are mapped to the higher-level components of the 2022 RACGP curriculum and syllabus for Australian general practice and are assessed. They are aligned to relevant professional regulatory requirements.

Although these competencies are expected at the point of Fellowship, some are achieved at an earlier stage in training. The Progressive capability profile of the general practitioner (the Profile) defines the development of the competencies and the progress towards this against key milestones in the training journey.

Therefore, the Statement of Fellowship outcomes is a statement of all the competencies to be expected at the point of Fellowship, while the Profile describes the development of these competencies.

In the Statement of Fellowship outcomes, the competencies are arranged by role and capability, as occurs in the Profile. Each outcomes competency has been mapped to the corresponding competency or competencies in the Profile. This mapping is indicated in the ‘Competency number’ column in Table 2.

Table 2. Statement of Fellowship outcomes

Role: Clinician (Patient orientation)
Capability	Competency	Competency number
Deliver culturally safe care	Respectfully identify Aboriginal and Torres Strait Islander people and barriers to self-identification	1.1.2
	Integrate cultural perspectives, beliefs and impacts of historical events into provision of culturally safe care to Aboriginal and Torres Strait Islander peoples	1.4.1
	Integrate cultural perspectives and beliefs into provision of culturally safe care in all cross-cultural consultations	1.4.3
Provide person-centred and comprehensive care, using a biopsychosocial approach	Demonstrate holistic person-centred care, applying a biopsychosocial approach	2.1.1
	Identify and acknowledge patients’ experiences, perspectives and expectations and integrate these into clinical care	2.2.1 2.4.1
Manage consultations and communicate effectively with patients, families and carers	Structure consultations to optimise engagement, efficiency and time management	3.3.1
	Effectively prioritise and set reasonable expectations for the consultation	3.4.3
	Establish a therapeutic relationship in routine and challenging encounters using effective communication adjusted to the patient needs, health literacy and context	3.2.1 3.2.2 3.4.1
	Communicate effectively with and incorporate views of family, carers and substitute decision-makers appropriately to improve care	3.3.3
	Explain relevant evidence to patients to support informed decisions	3.4.5
	Proactively use resources to minimise communication barriers	3.4.2
Collaborate and coordinate care (within healthcare teams and with other professional stakeholders)	Document organised diagnostic and therapeutic reasoning in clinical notes to facilitate quality continuity of care	4.3.1
	Provide continuity and effectively collaborate with healthcare teams to lead and coordinate recommendations	4.4.1
	Provide timely and appropriate referrals	4.3.3
	Use eHealth systems such as clinical software, telehealth or other digital health technologies appropriately to optimise patient care	4.3.4
Identify and manage uncertainty, and acute and undifferentiated presentations (across the lifespan and appropriate to context)	Appropriately diagnose and manage patients with acute conditions	5.3.1 5.4.3
	Take a history that identifies biological, psychological, social and cultural factors that may impact presentation and management of acute and chronic health conditions	5.2.2 5.3.1 2.3.2
	Perform an appropriate and respectful physical examination with consent	5.2.5 5.3.1
	Demonstrate high level clinical problem-solving, with ability to prioritise clinical issues, interpret and synthesise complex clinical assessment and diagnostic information to reach high probability diagnoses	5.3.2 5.3.4
	Reappraise diagnoses over time to minimise clinical reasoning errors	5.4.2
	Undertake rational, safe prescribing and medication monitoring	5.1.5 6.3.4
	Safely undertake procedures including taking informed consent appropriate to context and skill levels	5.1.3 5.3.3
	Use shared decision-making to align patient, family and carer values, goals and preferences to develop a personalised plan	5.4.3 5.4.4 3.4.4 6.4.3
	Consider benefits and harms of diagnostic and management options and counsel patients to support shared decision-making	5.3.1 5.3.3 6.3.1 6.3.5 10.3.2
	Organise appropriate follow-up	5.3.5
	Manage uncertainty and ongoing undifferentiated conditions	5.4.4
	Demonstrate an approach to urgent and emergent conditions including the identification of clinical deterioration and appropriate escalation of care	5.3.5 5.4.1
	Demonstrate principles of contemporary practice of basic and advanced life support	5.1.7 5.3.6
Manage individuals with chronic and complex conditions, providing continuity of care (across the lifespan and appropriate to context)	Provide holistic and rational chronic disease management	6.3.2
	Deliver appropriate surveillance of chronic conditions and impacts of comorbidities	6.4.1
	Provide continuity and establish appropriate models and collaborative goals of care with patients and their families that include self-management	6.4.3 6.3.3
	Identify impacts on individuals and their carers and provide support and education to optimise wellbeing and promote self-care	6.3.4
	Adapt communication strategies and provide patients with appropriate resources to optimise self-management	6.4.2
Promote health and deliver preventive care (across the lifespan and appropriate to context)	Provide evidence-based health promotion and access to screening, using recall systems	7.3.1
	Integrate understanding of stages of change and harm minimisation into patient care	7.4.1
	Use a range of strategies and resources to provide health education about normal life stages	7.4.2
Role: Health advocate and leader (community orientation)
Capability	Competency	Competency number
Rationally and responsibly use the healthcare system	Demonstrate understanding of limitations and judicious use of healthcare resources and correctly access government-funded programs (including the MBS)	8.3.1 8.4.1
	Demonstrate a rational and evidence-based approach to diagnostic and surveillance investigations	8.3.3
Identify and address contributors to health inequity and advocate for care access	Identify the impact of social, cultural and environmental determinants on local community health and access to care	9.3.1
	Identify and advocate for barriers to access to local community care to be addressed	9.3.3 9.4.3
	Identify strategies to improve health equity in the local community including appropriate health services and resources for referral	9.3.2 9.4.1
	Identify and manage emerging public health risks in the local community	9.4.2
Role: Ethical professional (Profession orientation)
Capability	Competency	Competency number
Maintain legal and duty of care responsibilities	Demonstrate respect for privacy and confidentiality and identify and manage situations where legal responsibilities override these	10.1.1 10.3.1 10.4.1
	Adhere to the appropriate statutory and regulatory requirements and maintain accurate medico-legal documentation	10.4.3 10.4.1
	Assess and provide safe management of individuals who refuse or withdraw consent for treatment	10.4.2
Demonstrate professional and ethical conduct	Distinguish personal beliefs, potential conflicts of interest and biases to minimise impacts on patient safety and access to quality care	11.3.2
	Identify threats to effective therapeutic relationships and boundaries and manage these ethically and professionally	11.3.3
	Identify ethical issues and access resources and support to manage them	11.3.1 11.4.1
	Identify and ethically support colleagues in difficulty	11.4.2
	Mentor colleagues and develop skills in debriefing after distressing experiences	11.4.3
Use self-reflection to deliver quality care and to enhance and maintain self-care practices	Independently develop plans to optimise personal wellbeing	12.3.3
	Regularly reflect on professionalism and ethical conduct and integrate into ongoing learning strategies	12.4.1
	Implement an ongoing plan to overcome professional isolation	12.4.2
	Access mentoring and support from colleagues for emotional reactions to distressing events	12.2.1
Engage in reflective practice and ongoing learning	Participate in professional development	13.3.2
	Evaluate quality of care delivered by self and peers against good practice exemplars including development and maintenance of procedural skills	13.3.1
	Identify gaps in practice relevant to community needs and develop strategies to address these	13.4.1
	Undertake regular reflective practice to improve cultural safety skills over time	13.4.2
Role: Scholar and scientist (Practice orientation)
Capability	Competency	Competency number
Integrate best available scientific evidence, teaching and research into practice	Integrate evidence-based and experiential knowledge to support diagnosis and management decisions	14.3.2
	Apply critical appraisal skills to research evidence to inform clinical practice	14.4.1
	Pose clinical questions that warrant being addressed with formal research	14.4.2
	Provide constructive feedback to colleagues on quality of clinical care	14.3.3
	Provide mentoring and education to colleagues	14.3.4
	Participate in research opportunities as available	14.3.5
Display commitment to practice quality and safety	Support quality clinical governance by participating and/or leading review of critical incidents and potential critical incidents including use of open disclosure practices	15.3.1 15.4.1
	Communicate with individuals and families about adverse events and counsel appropriately	15.3.2
	Evaluate practice, identify and lead quality improvement initiatives and/or participate in research such as clinical audits to promote quality and safe practice	15.3.3 15.4.3
	Use practice systems effectively to share responsibility for safe clinical care, such as through effective handover, follow up, recalls and reminders	15.4.2
	Ensure the work environment is safe and supported	15.4.4
	Describe the management of a general practice as an ethical and legal business	15.4.5

General practice training

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Morrison J, Clement T, Nestel D, Brown J. Perceptions of ad hoc supervision encounters in general practice training: A qualitative interview-based study. Aust Fam Physician 2015;44(12):926–32.

Prentice S, Kirkpatrick E, Schuwirth L, Benson J. Identifying the at-risk general practice trainee: A retrospective cohort meta-analysis of general practice registrar flagging. Adv Health Sci Educ Theory Pract 2021;26(3):1001–25.

Wearne SM, Butler L, Jones JA. Educating registrars in your practice. Aust Fam Physician 2016;45(5):274–77.

Wearne S, Magin P, Spike N. Preparation for general practice vocational training: Time for a rethink. Med J Aust 2018;209(2):52–54. doi: 10.5694/mja17.00379.

Wiener-Ogilvie S, Bennison J, Smith V. General practice training environment and its impact on preparedness. Educ Prim Care 2014;25(1):8–17. doi: 10.1080/14739879.2014.11494236.

Competency-based medical education

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Van Melle E, Frank JR, Holmboe ES, Dagnone D, Stockley D, Sherbino J. A core components framework for evaluating implementation of competency based medical education programs. Acad Med 2019;94(7):1002–09.

Competency and capability frameworks

Australia

Australian Medical Council. . Kingston, ACT: AMC, 2021. [Accessed 14 April 2022].

Fielding A, Mulquiney K, Canalese R, et al. A general practice workplace-based assessment instrument: Content and construct validity. Med Teach 2020;42(2):204–12. doi: 10.1080/0142159X.2019.1670336.

GP Synergy. General Practice Registrar Competency Grid (GPR-CAG). Liverpool, NSW: GP Synergy, 2013.

The Confederation of Post Graduate Medical ������Ƶ Councils. Version 3.1. Melbourne: CPMEC, 2012. [Accessed 14 April 2022].

������Ƶ. 2022 RACGP curriculum and syllabus for Australian general practice. East Melbourne, Vic: RACGP, 2022. [Accessed 7 June 2022].

������Ƶ. Clinical competency rubric 2021. East Melbourne, Vic: RACGP, 2021. [Accessed 28 March 2022].

������Ƶ. Curriculum for Australian General Practice 2016. East Melbourne, Vic: RACGP, 2016. [Accessed 14 April 2022].

������Ƶ. Curriculum for Australian General Practice 2016 – AH16 Aboriginal and Torres Strait Islander health. East Melbourne, Vic: RACGP, 2016. [Accessed 14 April 2022].

������Ƶ. Curriculum for Australian General Practice 2016 – RH16 Rural health. East Melbourne, Vic: RACGP, 2016. [Accessed 14 April 2022].

������Ƶ. Competency profile of the Australian general practitioner at the point of Fellowship. East Melbourne, Vic: RACGP, 2015. [Accessed 14 April 2022].

International

Accreditation Council for Graduate Medical ������Ƶ. . [Accessed 14 April 2022].

General Medical Council. London, GMC, 2017. [Accessed 14 April 2022].

NHG. . [Accessed 14 April 2022].

Primary Care Collaborative. Washington, DC: PCC, [date unknown]. [Accessed 14 April 2022].

Royal College of Physicians and Surgeons of Canada. Ottawa, ON: Royal College of Physicians and Surgeons of Canada, 2015. [Accessed 14 April 2022].

International curricula

Australian College of Rural and Remote Medicine. Rural generalist curriculum. Brisbane: ACRRM, 2021. [Accessed 14 April 2022]

Confederation of Postgraduate Medical ������Ƶ Councils. Australian curriculum framework for junior doctors. Version 3.1. Melbourne: CPMEC, 2012. [Accessed 14 April 2022].

Irish College of General Practitioners. Version 5.0. Dublin: ICGP, 2020. [Accessed 14 April 2022].

Royal College of General Practitioners. RCGP curriculum: London: RCGP, 2019. [Accessed 14 April 2022].

Royal Australasian College of Physicians. Sydney: RACP, 2013. [Accessed 14 April 2022].

The Royal New Zealand College of General Practitioners. Wellington: RNZCGP, 2014. [Accessed 14 April 2022].

Selection milestone competencies

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Patterson F, Cleland J, Cousans F. Selection methods in healthcare professions: Where are we now and where next? Adv Health Sci Educ Theory Pract 2017;22(2):229–42.

Roberts C, Khanna P, Rigby L, et al. Utility of selection methods for specialist medical training: A BEME (best evidence medical education) systematic review: BEME guide no. 45. Med Teach 2018;40(1):3–19.

Vermeulen MI, Kuyvenhoven MM, Zuithoff NPA, van der Graaf Y, Damoiseaux RA. Dutch postgraduate GP selection procedure; reliability of interview assessments. BMC Fam Pract 2013;14:43. doi: 10.1186/1471-2296-14-43.

Foundation/safety assessment competencies

Ingham G, Plastow K, Kippen R, White N. A ‘call for help’ list for Australian general practice registrars. Aust J Gen Pract 2020;49(5):280–87.

Workplace-based assessment and entrustment levels

Benson J, Kirkpatrick E, Schuwirth L. Workplace based assessments in postgraduate medical education: A hermeneutic review. Med Educ 2020;54(11):981–92.

ten Cate O, Hart D, Ankel F, et al. Entrustment decision making in clinical training. Acad Med 2016;91(2):191–98.

ten Cate O, Tobin S, Stokes ML. Bringing competencies closer to day-to-day clinical work through entrustable professional activities. Med J Aust 2017;206(1):14–16.

Royal College of General Practitioners. Workplace based assessment WPBA. London: RCGP, 2022. [Accessed 19 April 2022].

Sagasser MH, Fluit LCRMG, Van der Vleuten C. How entrustment is informed by holistic judgments across time in a family medicine residency program. Acad Med 2017;92(6):792–99.

Teherani A, Chen HC. The next steps in competency-based medical education: Milestones, entrustable professional activities and observable practice activities. J Gen Intern Med 2014;29(8):1090–92.

Valentine N, Wignes J, Benson J, Clota S, Schuwirth LWT. Entrustable professional activities for workplace assessment of general practice trainees. Med J Aust 2019;210(8):354–59.

Validity of specific competency measures

Fielding A, Mulquiney K, Canalese R, et al. A general practice workplace-based assessment instrument: Content and construct validity. Med Teach 2020;42(2):204–12. doi: 10.1080/0142159X.2019.1670336.

Hawkins RE, Margolis MJ, Durning SJ, Norcini JJ. Constructing a validity argument for the mini-clinical evaluation exercise: A review of the research. Acad Med 2010;85(9):1453–61.

Lineberry M, Soo PY, Cook DA, Yudkowsky R. Making the case for mastery learning assessments: Key issues in validation and justification. Acad Med 2015;90(11):1445–50.

Specific competencies

Aboriginal and Torres Strait Islander Health competencies

The Wardliparingga Aboriginal Research Unit of the South Australian Health and Medical Research Institute.  Sydney: Australian Commission on Safety and Quality in Health Care, 2017. [Accessed 19 April 2022].

Evidence-based practice

Galbraith K, Ward A, Heneghan C. A real-world approach to evidence-based medicine general practice: A competency framework derived from a systematic review and Delphi process. BMC Med Educ 2017;17(1):78.

Evaluative judgement competencies

Beaman M, Brown J, Kirby C, Ajjawi R. Feedback that helps trainees learn to practice without supervision. Acad Med 2021;96(2):205–09.

Bruen C, Kreiter C, Wade V, Pawlikowska T. Investigating a self-scoring interview simulation for learning and assessment in the medical consultation. Adv Med Educ Pract 2017;8:353–58.

Tai J, Ajjawi R, Boud D, Dawson P, Panadero E. Developing evaluative judgement: Enabling students to make decisions about the quality of work. High Educ 2018;76:467–81.

Professionalism

Hodges BD, Ginsburg S, Cruess R, et al. Assessment of professionalism: Recommendations from the Ottawa 2010 Conference. Med Teach 2011;33(5):354–363. doi: 10.3109/0142159X.2011.577300.

Lucey C, Souba W. Perspective: The problem with the problem of professionalism. Acad Med 2010;85(6):1018–24.

Quality improvement competencies

Czabanowska K, Klemic-Ketis Z, Potter A, et al. Development of a competency framework for quality improvement in family medicine: A qualitative study. J Contin Educ Health Prof 2012;32(93):174–80.

 

This glossary defines terms used in About the progressive capability profile of the general practitioner and throughout the Profile.
 

Advanced life support	The provision of effective airway management, ventilation of the lungs and production of a circulation by means of techniques additional to those of basic life support. These techniques may include, but are not limited to, advanced airway management, vascular/drug therapy and defibrillation according to the most current version of the Australian Resuscitation Council guidelines. Refs: . [Accessed 20 April 2020]. ������Ƶ. Basic life support and advanced life support guidance document. East Melbourne, Vic: RACGP, 2020. [Accessed 20 April 2022].
Basic life support	The preservation of life by the initial establishment, and/or maintenance, of airway, breathing, circulation and related emergency care, including use of an automated external defibrillator, according to the most current version of the Australian Resuscitation Council guidelines. Refs: . [Accessed 20 April 2022]. ������Ƶ. Basic life support and advanced life support guidance document. East Melbourne, Vic: RACGP, 2020. [Accessed 20 April 2022].
Biopsychosocial approach	A holistic clinical approach to assessment, diagnosis and management that considers biological, psychological and social contributing factors and their complex interactions that impact how individuals may present for care. Ref: Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137(5):535–44. doi: 10.1176/ajp.137.5.535
Capability	A high-level ability required of a GP.
Codified knowledge	Knowledge that can be described and understood with language.
Colleagues	Professionals with whom the doctor directly works within the same practice, or indirectly works or collaborates with through the broader healthcare system, including other GPs, nursing and administrative staff, allied health professionals and non-GP specialists.
Compassion fatigue	‘A natural consequence of working with people who have experienced stressful events’. This develops because of a doctor’s exposure to their patients’ experiences combined with their empathy for the patient. Symptoms include helplessness, feelings of overwhelm and confusion, isolation, exhaustion with consequent dysfunction, and concerns about own capacity. Ref: Benson J, Magraith K. Compassion fatigue and burnout: The role of Balint groups. Aust Fam Physician 2005;34(6):497–98.
Competency	‘An observable ability of a health professional, integrating knowledge, skills, values, and attitudes. Since competencies are observable, they can be measured and assessed. Competencies can be assembled like building blocks to facilitate progressive development.’ Ref: Frank JR, Mungroo R, Ahmad Y, Wang M, De Rossi S, Horsley T. Toward a definition of competency based education in medicine: A systematic review of published definitions. Med Teach 2010;32(8):631–37. doi: 10.3109/0142159X.2010.500898
Conflicts of interest	Refers to the importance of acknowledging and addressing any biases an individual doctor may have that may impact the quality or safety of care delivered. For example, prescribing habits that are not in line with evidence-based guidelines (eg the GP having a pecuniary interest in a particular treatment being prescribed, or being incentivised through other means to prescribe a particular treatment).
Continuity of care	The quality provision of care over time, including the individual patient’s experience of a ‘continuous caring relationship’ with an individual doctor over time, as well as multidimensional models where different providers provide a ‘seamless service’ by integrating, coordinating and sharing information. Ref: Guilford M, Naithani S, Morgan M. What is ‘continuity of care’? J Health Serv Res Policy 2006;11(4):248–50. doi: 10.1258/135581906778476490
Cross-cultural consultations	Consultations in which the doctor has a different cultural and/or linguistic background to the patient. The emphasis is on the need for the doctor to be culturally aware and provide culturally safe care.
Cultural assessment	The basic premise of cultural assessments is that patients have a right to their cultural beliefs, values and practices, and these factors should be understood, respected and considered when giving culturally competent care. A comprehensive cultural assessment allows the practitioner to gain an understanding of how embedded the individual is in their culture and its belief system, which may provide insight into perceptions of cause, meanings of illness, and expectations of treatment and care.
Cultural awareness	Cultural awareness is sensitivity to the similarities and differences that exist between two different cultures and the use of this sensitivity in effective communication with members of another cultural group. Cultural awareness education is the first building block towards cultural safety. Cultural awareness education is defined as, ‘An understanding of how a person’s culture may inform their values, behaviours, beliefs, and basic assumptions ... [It] recognises that we are all shaped by our cultural background, which influences how we interpret the world around us, perceive ourselves and relate to other people. The focus of cultural awareness education is on outcomes for the participant or learner – that is, self-reflection leading to enhanced cultural awareness. It is introductory in nature, and through increased awareness, the learner can enhance their skills in working effectively with Aboriginal and Torres Strait Islander people.’ Ref: ������Ƶ. Cultural awareness education and cultural and safety training. East Melbourne, Vic: RACGP, [date unknown]. [Accessed 20 April 2022].
Cultural bias	Cultural bias may be defined as interpreting and judging phenomena by standards inherent in one’s own culture. In healthcare, this can contribute to misunderstandings that impact diagnosis and consequent management, power imbalances in the patient–doctor relationship, as well as bring up issues of class in some cultures.
Cultural lens	The doctor’s unique personal worldview influenced by the cultures that nurtured them. This lens may influence the way a health professional judges and makes assumptions about patients from a different background. Recognising this cultural bias is a necessary step for clinical effectiveness. A patient’s cultural lens shapes beliefs about illness causation, the nature of a particular illness, and the appropriate treatment and expected outcome; it is therefore important for health professionals to factor this in when developing a collaborative therapeutic relationship. Ref: Klein HA. Cognition in natural settings: The cultural lens model. In: Kaplan M, editor. Advances in human performance and cognitive engineering research. Vol, 4, Cultural ergonomics. Bingley, UK: Emerald Group Publishing Ltd, 2004; p. 249–80. doi: 10.1016/S1479-3601(03)04009-8
Cultural safety	Cultural safety is an important part of the spectrum of cultural competency and is defined not by the clinician but by the individual patient’s experience. The emphasis for cultural safety is on reflective practice, and acknowledgement and respect for differences rather than awareness of culturally specific beliefs or practices. Cultural safety involves the development of awareness of power imbalances in the therapeutic relationship that can negatively impact the quality of care, and the development of strategies to minimise this. Practitioner safety is another important aspect of cultural safety. Every clinician should feel safe in their clinic environment, regardless of their cultural or linguistic background. Ref: The Wardliparingga Aboriginal Research Unit of the South Australian Health and Medical Research Institute. National Safety and Quality Health Service Standards user guide for Aboriginal and Torres Strait Islander health. Sydney: Australian Commission on Safety and Quality in Health Care, 2017.
Culturally and linguistically diverse	This term is typically used to describe individuals in Australia who were born overseas, have a parent born overseas, or speak a variety of languages other than English. In the Profile, this term is used more inclusively, acknowledging that we are on the lands of Aboriginal and Torres Strait Islander peoples, the longest surviving culture in the world. The term describes individuals who have a different cultural and/or linguistic background to the doctor, regardless of the doctor’s cultural or linguistic background. The emphasis is on the need to be culturally aware and to provide culturally safe care. Ref: Australian Institute of Health and Welfare. Australia’s health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW, 2018.
Disability	Refers to a physical, sensory, intellectual or psychological impairment that causes some level of restriction or limitation to activities or to an individual’s ability to participate in everyday activities.
Duty of care	The legal and ethical obligation for doctors to adhere to standards of quality care in therapeutic relationships with patients. Ref: Dean J, Mahar P, Loh E, Ludlow K. Duty of care or a matter of conduct: Can a doctor refuse a person in need of urgent medical attention? Aust Fam Physician 2013;42(10):746–48.
Effective health education	Refers to the provision of accurate and timely evidence-based, quality health information and decision aids to patients by means most appropriate to their individual context (taking into account sociocultural factors and level of health literacy).
Effective therapeutic relationship	GPs often develop a comprehensive understanding of their patients through providing quality continuity of care across the lifespan. By using effective communication and delivering confidential and holistic care focused on the biopsychosocial-cultural perspective and priorities of the individual, GPs are uniquely situated to establish trust and to work as a team with individuals, their families and/or carers, to enable patient-centred quality diagnosis and management, and improved health outcomes. This is termed an ‘effective therapeutic relationship’.
Ethical issues	Ethical issues may arise when there are apparent contradictions between the elements of a GP’s ethical code and that of the patient and broader society.
Evaluative judgement	The capability to make decisions about the quality of one’s own work and that of others. It has been shown to be an effective way for learners to continually improve their work and to drive self-directed learning.
Gender-concordant care	Consideration of an individual’s preference to consult a GP of the same gender, particularly for intimate examinations. This preference may be related to personal factors, such as gender or sexual diversity, or cultural or religious beliefs.
Government-funded programs	This relates to both healthcare and social programs that provide support to individuals, including unemployment benefits, workers compensation and transport accident schemes, and Medicare-funded programs (including chronic disease management plans and access to allied health visits, mental health care plans, Aboriginal and Torres Strait Islander health assessments).
‘Heartsink’ response	‘The feelings in the pit of your stomach when a specific patient’s name is seen on the appointment list.’ This traditionally pejorative term has been used to refer to the response a doctor has to patients with a variety of complex presentations that trigger feelings of frustration, distress or inadequacy in the doctor that are typically related to transference and countertransference. These responses should identify a need for reflection by the doctor and consideration of strategies to manage these interactions to optimise the care provided. Ref: O'Dowd TC. Five years of heartsink patients in general practice. BMJ. 1988;297(6647):528–30. doi: 10.1136/bmj.297.6647.528
Holistic person-centred care	A core value of general practice that is based on trust and a therapeutic relationship, and that relates to: treating each individual as a multidimensional person (considering multiple personal and contextual factors that influence health and treatment) according to their needs length, depth and breadth of scope: ‘cradle to grave’, multisystem care that is tailored to the individual, is integrated and provides a range of treatment modalities and opportunistic and preventive care beyond the presenting complaint and within the context of a healthcare team. Ref: Thomas H, Best M, Mitchell G. Whole-person care in general practice: The nature of whole person care Aust J Gen Pract 2020;49(1–2):54–60.
Hypothetical deductive reasoning	A process of clinical reasoning where hypotheses are considered for potential diagnoses based on clinical findings that are presented sequentially. Ref: Barrows HS. Practice based learning: Problem-based learning applied to medical education. Springfield IL: Southern Illinois University, School of Medicine, 1994. Linn A, Kildea H, Tonkin A, Khaw C. Clinical reasoning: A guide to improving teaching and practice. Aust Fam Physician 2012;41(1):18–20.
Intellectual humility	A cognitive phenomenon related to metacognition, in which individuals recognise the limitations of their own thinking, beliefs and attitudes and are open to learning from the experience of others. This method of thinking is about being actively curious in regard to intellectual blind spots. Ref: . [Accessed 20 April 2022].
Intersectionality	The ways in which different aspects of a person’s personality expose them to overlapping forms of discrimination and marginalisation.
Near misses	An unplanned event that had the potential to cause harm but did not actually result in harm.
Patient’s agenda and priorities	A patient’s agenda relates to the list of issues that the individual wishes to cover within the consultation that are usually clearly expressed; for example, accessing an opinion on a new symptom, review of an ongoing symptom, a repeat script or a certificate for work. A patient’s priorities relates to the broad set of issues in an individual’s life, beyond their immediate agenda for the consultation, that may impact their presentation, ability to communicate about and/or manage their health, and/or their access to the care required. Priorities may not always be obvious or discussed, but within the continuity of care provided in general practice, GPs are often aware of these issues and need to integrate consideration of these into person-centred care. An example of an important priority to consider may be an individual’s socioeconomic situation with pressure to work long hours to support their family or provide care to a dependent family member, which impacts their ability to prioritise their health by creating barriers to exercising regularly or attending appointments.
Peers	Refers to GP colleagues who are at a similar level of experience and/or training as the doctor.
PICO framework	The PICO framework can be used to build clinical questions that are directly relevant to the problem at hand to assist in undertaking a review of guidelines and/or the broader literature that guides evidence-based care: P – Patient, population or problem being addressed I –   Intervention being considered, which may include exposure to a risk factor, diagnostic test, therapy or patient perception C – Comparison intervention or exposure or considering the alternative(s); for example, do nothing, surgery, different pharmacological or non-pharmacological therapy, placebo effect O – Clinical outcome of interest; for example, morbidity, complications, mortality. Ref: Schardt C, Adams MB, Owens, T, Keitz, S, Fontelo, P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak 2007;7(16). doi: 10.1186/1472-6947-7-16
Privileging/Privileges	Privileging (a concept from the entrustment literature) is the act of granting a registrar a privilege to a scope of clinical practice after an assessment of their competency. The milestones of the Profile are privileging points. They define the entitlement to work within a specific scope of practice that gradually expands as competencies are attained with progression across the milestones of training. These privileges are linked with varying levels of supervision and include entering a general practice training program, working in a general practice setting under direct, indirect then ad hoc supervision, admission to Fellowship and ongoing status as a Fellow.
Red flags	Encompasses a broad range of considerations, including specific signs and symptoms considered in combination with individual risk factors that may indicate the presence of a serious health condition that requires intervention.
Reflective practice	‘The ability to reflect on one’s actions so as to engage in a process of continuous learning.’ The ongoing process of a doctor critically reviewing their experiences and thought processes to gain an understanding of themselves, their behaviour and clinical knowledge and skills, in their interactions with patients and colleagues, to inform ongoing learning. Ref: Schon, DA. The reflective practitioner: How professionals think in action. New York: Basic Books,1983.
Self-awareness	A professional’s ability to be reflective and develop a clear perception of their own personality, communication style, knowledge base, thoughts, beliefs, possible biases, motivation, values and emotions. This enables insight into how they may be perceived by others and how to minimise risks of problems with communication or professional and therapeutic relationships.
Self-management	The ability of individuals to promote their own health by maintaining healthy behaviours, lifestyle choices and concordance with recommended treatments, as well as, where relevant, self-monitoring strategies to minimise impacts of existing chronic diseases. Effective self-management is based on an individual having a good understanding of their condition and when to access healthcare. Ref: . [Accessed 20 April 2022].
Social determinants	Social determinants are the conditions of the environment where people live, learn, work, play and worship, and their age, that affect their health, ability to function and the quality of their life outcomes.
Stages of change	An intentional change model developed by Prochaska and DiClemente that focuses on the decision-making and motivation stages of an individual in regard to behaviour change.
Transference/ Countertransference	‘Transference’ refers to the phenomenon by which individuals ‘unconsciously transfer feelings and attitudes from a person or situation in the past on to a person or situation in the present. The process is at least partly inappropriate to the present’. This process is unconscious and can occur in either direction in the patient–doctor relationship. Risk factors for transference include mental health diagnosis or vulnerable personality, particularly individuals with experience of previous trauma (eg complex post-traumatic stress disorder, severe depression or anxiety), perceptions of dependence, associated anxiety about physical or psychological safety, and frequency of contact (inside or outside of the clinic). ‘Countertransference’ refers to the response elicited in the GP by the patient’s transference communications. It is important for GPs to recognise when this is occurring and to address it empathically and respectfully, and to reach agreement with the patient on clear therapeutic boundaries. A potential consequence of unclear boundaries is the development of unreasonable patient expectations that are unable to be met, and that may put the patient at risk or raise the possibility of legal action. Ref: Hughes P, Kerr I. Transference and countertransference in communication between doctor and patient. Advances in psychiatric treatment. Cambridge University Press, 2000;6(1):57–64. doi: 10.1192/apt.6.1.57
Trauma-informed care	An approach to clinical practice that acknowledges that doctors need to have a holistic view of the individual’s life situation to provide effective healthcare, including recognising the broad impact of trauma and understanding paths to recovery that avoid retraumatisation. Ref. . [Accessed 28 March 2022].
Vicarious trauma	The process of change resulting from empathic engagement with trauma survivors. Anyone who engages empathically with survivors of traumatic incidents, torture or material relating to their trauma, is potentially affected, including doctors. Ref: . A [Accessed 28 March 2022].