Remediation

Learning Needs and Interventions

1. Prerequisites for Learning

Awareness of context
Ability to learn from experience
Interpersonal skills
Common sense

Possible Causes

Lack of Awareness of context
Lack of Ability to learn from experience
Lack of Interpersonal skills
Lack of Common sense

Interventions

Think out loud - self-reflection / case presentation: Encourages individuals to verbalize their thoughts and reflections during case presentations to enhance self-awareness and critical thinking.
Stop, look, and listen: A mindfulness technique that involves pausing, observing, and listening to one's surroundings to improve focus and presence.
Mindfulness training: Training sessions aimed at developing mindfulness skills to reduce stress and improve concentration.
Case review: Reviewing cases to identify strengths and areas for improvement, fostering a deeper understanding of clinical practice.
Video review: Analyzing recorded consultations to gain insights into communication skills and clinical techniques.
Micro-step analysis of process: Breaking down processes into small, manageable steps to identify inefficiencies and areas for improvement.
What if...?: A technique that involves considering hypothetical scenarios to explore different outcomes and enhance problem-solving skills.
Ensure no specific learning difficulties (e.g., dyslexia, auditory processing problems): Identifying and addressing any specific learning difficulties to ensure effective learning.
External Clinical Teaching (ECT) visit: Observing a consultation and providing constructive feedback in line with RACGP policy of ‘assessment for learning’.

2. Medical Knowledge
Lack of medical knowledge
Lack of ability to apply knowledge to case context

Possible Causes

Not enough study
Ineffective study
Inappropriate resources
Learning or language difficulty
Limited exposure in clinical practice to particular patient populations
Financial or personal stressors limiting protected learning time

Interventions

Complete the self-assessment grid, discomfort log, etc.
Develop a structured and timed study plan incorporating strategies and commitments.
Attend all relevant workshops.
Teach others and present cases to learn teaching skills.
Evaluate learning style and plan accordingly.
Complete Self-Assessment Practice Tests (SAPTs) from GP Learning website for the previous 2 years.
Read and reflect on RACGP curriculum and syllabus.
Read and reflect on Clinical Competency Examination (CCE) rubric.
Organize and participate in ECT visit.
Attend all evening Webinar series.
Participate in Post Exam Support Intensive Program (PESIP) workshops.

3. Lack of communication skills

Comprehension, confidence, expressive capability
Active listening skills
Empathy
Clarity and conciseness
Non-verbal communication skills
Patient education skills
Cultural sensitivity
Ability to ask open-ended questions
Performance anxiety management
Proficiency in English as a second language
Ability to manage learning difficulties such as ADHD and dyslexia
Attention to detail in patient presentations (either written or aural) - learner may miss ends of sentences or even whole sentences/paragraphs, particularly in written information
Ability to identify the action and qualifier in exam questions
Patient-centeredness

Possible CausesLack of communication skills

comprehension, confidence, expressive capability
English being second language
Learning difficulty - ADHD, dyslexia
Anxiety
cultural communication differences

Interventions

Direct observation: Supervisor observes registrar's consultation and provides constructive feedback.
Reverse direct observation: Registrar observes the supervisor's consultation and reflects.
Random Case Analysis (RCA): Supervisor provides feedback on randomly picked cases that the registrar has done previously.
Case-Based Discussion (CBD): Supervisor and registrar discuss a case based on a real consultation or journal article.
Role play session: Supervisor role-plays a patient with the registrar.
Recorded session review: Supervisor reviews and provides feedback after reviewing a video recording of a registrar's consultation.
Multi-source feedback (MSF) session: Registrar reflects (with the supervisor) on the MSF obtained from various sources including patients, colleagues, staff, and other stakeholders.
Read and reflect on RACGP curriculum and syllabus.
Read and reflect on CCE rubric.
Organize and attend communication skill specialist sessions.
Obtain a psychological and educational assessment of any underlying medical issues.
Participate in video-recorded Objective Structured Clinical Competence assessment involving role players and obtain constructive feedback.

4. Lack of consultation skills

Ability to gather focused information
Targeted examination skills
Choosing relevant investigations
Creating a differential diagnosis and problem list
Evidence based and contextual initial management strategies
Identifying red flags
Considering social and community aspects
Providing patient education
Recognizing referral pathways
Identifying key features of relevant conditions, known as the 'illness script,'
Patient-centeredness ability and awareness

Possible Causes

Lack of medical knowledge
Cognitive biases
Lack of experiential learning
Lack of clinical reasoning skills

Interventions

Direct observation: Supervisor observes registrar's consultation and provides constructive feedback.
Reverse direct observation: Registrar observes the supervisor's consultation and reflects.
Random Case Analysis (RCA): Supervisor provides feedback on randomly picked cases that the registrar has done previously.
Case-Based Discussion (CBD): Supervisor and registrar discuss a case based on a real consultation or journal article.
Role play session: Supervisor role-plays a patient with the registrar.
Recorded session review: Supervisor reviews and provides feedback after reviewing a video recording of a registrar's consultation.
Multi-source feedback (MSF) session: Registrar reflects (with the supervisor) on the MSF obtained from various sources including patients, colleagues, staff, and other stakeholders.
Read and reflect on RACGP curriculum and syllabus.
Read and reflect on CCE rubric.
Organize and attend communication skill specialist sessions.
Obtain a psychological and educational assessment of any underlying medical issues.
Participate in video-recorded Objective Structured Clinical Competence assessment involving role players and obtain constructive feedback.
Organize and participate in ECT visit.
Participate in Post Exam Support Intensive Program (PESIP) workshops.
Focused Sessions with experienced ME

5. Lack of clinical reasoning and decision making ability

Identification of key features
Problem representation and 'illness script'
Structured problem solving approach
information gathering
interpretation of a context
prioritization
hypothesis generation
testing hypothesis
Reflection
Cognitive biases
evidence based practice
Time management
Experiential learning

Possible Causes•Poor reflection and metacognitive skills
•Unawareness or inexperience in using different reasoning models
•Over-reliance on Type 1 (pattern recognition) thinking
Interventions

Think out loud - self-reflection / case presentation: Encourages individuals to verbalize their thoughts and reflections during case presentation
Random Case Analysis (RCA): Supervisor provides feedback on randomly picked cases that the registrar has done previously. ( consultation / pathology inbox / referral letters)
Case-Based Discussion (CBD): Supervisor and registrar discuss a case based on a real consultation or journal article.
Role play session: Supervisor role-plays a patient with the registrar.
Recorded session review: Supervisor reviews and provides feedback after reviewing a video recording of a registrar's consultation.
Organize and attend communication skill specialist sessions.
Participate in video-recorded Objective Structured Clinical Competence assessment involving role players and obtain constructive feedback.
Organize and participate in ECT visit.
Participate in Post Exam Support Intensive Program (PESIP) workshops.
Focused Sessions with experienced ME
Adequate case number and diversity of exposure
Case deconstruction including review
- consult structure
- understanding context
- problem representation
- Hypothetico - deductive approach
- Challenge cognitive biases
- Targeted vs scattergun information gathering
- prioritization of decision making
- Taking patient's perspective
Overt teaching about clinical reasoning models eg with ME, IMReasoning Podcast
Clinical Reasoning Game
Problem, Question, Reasoning, Solution, Teaching (PQRST) framework for supervisor/practice based teaching
Reflective patient logs
Participate in video-recorded Objective Structured Clinical Competence assessment involving role players and obtain constructive feedback.

6. Lack of ability to apply knowledge

Unable to see a connection between work and study
Approach to problems in general practice is either too rigid or lacking structure
Asking 'silly questions' or repetitive questions to their supervisor
Disorganized presentation of cases to supervisor or in education
Unable to identify and understand the significance of history, examination and investigation features in the patient scenario or SAPT question
Inadequate differential diagnosis or differential not applicable to scenario
Missing context -management and investigation plans are vague, non-specific to scenario, or lack reference to clinical guidelines Possible Causes
Poor integration of studied knowledge for application to presentation-based scenarios (ie studying topics rather than presentations)
Inability to form a concise yet complex problem representation eg using noun groups, chucking into illness scripts
Lack of synthesis (ie drawing accurate conclusions from information given)

Interventions

All interventions included under lack of consultation skills and communication skills

Additional interventions:

Practice presentation-based learning plan making use of 'sticky learning' strategies
Learner generated autofill prompts for use in clinic to consolidate approach to frequent presentations
Each consult to include where relevant: problem representation, differential diagnosis, problem list

7. Lack of specific skill set

- Physical examination
- Procedural skills
- Notes writing
- Rural health

Possible Causes

Lack of awareness
Lack of exposure in that field
Lack of motivation and interest

Interventions

Identify the cause and address
Autofill or dictation software
Motivational interviewing

8. System Issues

Lack of adequate supervision
Low patient number
Inadequate mix of GP patients
Registrar - supervisor mismatch

Possible Causes

Supervisor too busy or lack of interest or lack of motivation
Too many doctors. Inadequate patient load
Inadequate mix of patients
Registrar supervisor mis-match
Inappropriate practice for this registrar

Interventions

Involve supervisor liaison officer.
Review accreditation requirement met
Discuss with practice manager
Involve other supervisor in the same practice
May need to change practice

9. Professionalism

Punctuality and dependability
Proactive attitude
Administrative compliance
Patient centered care
Integrity and confidentiality
Honesty and integrity
Respect
accountability
ability to provide and receive feedback
Dressup and presentation
Collaboration and team work

Possible Causes

Poor understanding of professional behavior
Lack of awareness of the impact of actions on others
Insufficient role modeling
Inadequate feedback mechanisms
Cultural differences
Poor time management skills
Personal or external stressors
Inadequate planning and organization
Lack of understanding of administrative processes
Poor organizational skills
Inadequate training on administrative tasks
Lack of motivation or interest in administrative duties
Lack of awareness of professional dress codes
Personal preferences conflicting with professional standards
Inadequate role modeling

Interventions

Role play
Mentoring - on specific professional issue
Role modeling
Specific individualized feedback
Policy review
self assessment and reflection
Motivational interviewing
Boost confidence
Peer benchmarking
modules on professionalism on RACGP GP learning
ECT visit

10. Inherent characteristics

comprehensive care
Continuity of care
Person centered care
Holistic approach
coordination of care
Community orientation
Accessibility / follow up

Possible Causes

Lack of understanding of patient perspectives
Insufficient emphasis on holistic care
Limited communication skills
Lack of empathy
Cultural insensitivity

Interventions

Mentorship - paring with experienced registrar / supervisor
Simulation Training - role playing sessions
Workshops and Seminars - focusing on pt centered consultation
Reflective Practice - self-reflection and feedback
Peer Learning Groups - group discussion
Feedback Sessions -
Online Courses - on GP learning
ECT visit
Regular audits and feedback on administrative performance
Training sessions on administrative processes and compliance

11. Health of individual and family

Home situation
Support network
Doctor's health
Financials
Work life balance

Possible Causes

Underlying physical, mental, cultural, emotional or spiritual unwellness
Family pressures
Lack of work-life balance leading to neglect of self-care
Role conflict -not understanding what an Australian GP is/does, or inability to balance personal with
Rural issues

Interventions

Psychological interventions - CBT, Mindfulness
GP referral
Workplace modifications
Increase flexibility - work life balance
Home situation assessment and offering support
Reverse direct observation
Group norming through small group workshops