Advanced Skill Training
In addition to training in general practice and emergency medicine, all rural generalists have an advanced skill in a specialised area. Advanced Skill Training can take 12-24 months to complete and forms an integral part of rural generalist training. The advanced skill options offered by the two general practice training colleges, ACRRM and RACGP, are set out below.
Advanced skill training is referred to as Advanced Specialised Training (AST) for ACRRM trainees and Additional Rural Skills Training (ARST) for RACGP trainees. Both colleges offer similar advanced skill opportunities, but there are some variations in training and assessment requirements, so trainees are encouraged to liaise directly with their GP college to ensure they meet all requirements for fellowship.
Please visit the ACRRM and RACGP websites for further information about the advanced skill training requirements and opportunities available.
Please visit the ACRRM website for further information about ACRRM accredited training posts.
Additional training in Aboriginal and Torres Strait Islander Health will equip the practitioner with the skills and knowledge to contribute meaningfully to initiatives targeted at closing the health inequality gap. Practitioners will develop a deeper understanding of the cultural considerations for healthcare delivery, with learning supported through cultural mentorship. Practitioners will also learn in detail about the bio-psycho-social model of healthcare and its importance for First Nations people, including understanding the influence of history and intergenerational trauma on health outcomes. Finally, Aboriginal and Torres Strait Islander Health requires a flexible, team approach, with working in collaboration with First Nations staff key to patient engagement.
In Western Australia, the training will normally be undertaken in an accredited Aboriginal Community Controlled Health Organisation in a rural or remote location. On a case-by-case basis, it can also be completed in another health service with a predominantly Aboriginal and Torres Strait Islander population.
Both ACRRM and RACGP offer advanced skill training in Aboriginal and Torres Strait Islander Health with training to be undertaken across a minimum period of 12 months full-time equivalent at an accredited training post.
Contributing to and engaging with academic medicine is a key component of rounded medical practice. Rural generalists, like all specialists, are expected to contribute to scholarly activities that improve healthcare delivery for their patients. Utilising evidence-based medicine is fundamental to clinical practice, and rural generalists with further training in academic medicine will further develop their skills in critical thinking and appraisal of academic publications. Developing an understanding of how to translate academic research to patient care initiatives, with consideration of the rural context, is key to improving patient care. In addition to utilising the results of medical research to deliver evidence-based care, clinicians with additional training in academic medicine are expected to undertake research activities, with a focus on rural and remote medicine. Additional training in academic medicine will upskill rural generalists in the domains of curriculum development, teaching and learning strategies, and generating educational resources.
Both ACRRM and RACGP offer advanced skill training in academic medicine, and it is recommend that the training be undertaken concurrently with clinical practice. This advanced skill is referred to as ‘Academic Practice’ with ACRRM and ‘Academic Post’ with RACGP. For RACGP trainees, it is only available through the Australian General Practice Training program.
An aging population brings with it an increasing burden of chronic health conditions and associated strain on the healthcare system. Whilst a rural generalist will be comfortable managing many acute and chronic conditions in primary practice, undertaking advanced skill training in adult internal medicine will allow them to develop the skills and knowledge to manage inpatients with conditions of higher complexity and acuity. Rural generalists with inpatient admission capacity are a key component of the rural health framework, allowing rural communities to access acute medical care closer to home.
Rural generalists working in adult internal medicine will enjoy a varied workload due to their wide scope of practice and the lack of local specialty services. In comparison to primary practice, which is typically limited by short consultation times, inpatient medicine has the benefit of providing the clinician with the time to thoroughly investigate diagnostic conundrums, including performing procedures with diagnostic and/or therapeutic value. Rural generalists who undertake additional training in adult internal medicine may elect to tailor their training to a sub-speciality that is in demand for their local community. For example, a rural generalist in the Kimberley region may chose to focus on nephrology due to the high rates of chronic kidney disease and demand for local dialysis care.
Both ACRRM and RACGP offer advanced skill training in adult internal medicine with training to be undertaken across a minimum period of 12 months full-time equivalent at an accredited training post.
The provision of anaesthetic services in rural and remote Australia is essential for the longevity of hospital services such as obstetrics and surgery. A rural generalist with an advanced skill in anaesthesia is typically referred to as a rural generalist anaesthetist. Rural generalist anaesthetists play a critical role in the wider surgical team, with their skills and knowledge required throughout the patient’s perioperative journey. In addition to the provision of anaesthesia during surgery, rural generalist anaesthetists contribute to the preoperative optimisation of the patient, including resuscitation where required, and the postoperative management of patients including optimisation of pain relief. Additionally, rural generalist anaesthetists play a key role in retrieval medicine due to their high-level skills in life support measures. Anaesthesia has a significant procedural element, with airway management and regional anaesthesia a key component of a rural generalist anaesthetist’s day-to-day work.
Both ACRRM and RACGP offer advanced skill training in anaesthesia, with completion of the Rural Generalist Anaesthesia (RGA) Training Program required. The RGA is delivered by the Australian and New Zealand College of Anaesthetists (ANZCA) in partnership with ACRRM and RACGP. The qualification requires completing a minimum period of 12 months full-time equivalent at an accredited training post and passing the prescribed assessments and examinations. Key components of the curriculum include procedural skills such as airway management and regional anaesthesia, perioperative patient care, and resuscitation of critically unwell patients.
By definition, a rural generalist must have some experience and skills in emergency medicine, and this is mandated in the rural generalists training pathways for both ACRRM and RACGP. However, trainees can elect to complete additional training in emergency medicine to fulfill the requirements for an advanced skill in this specialty. This brings with it increased scope of practice, including complex procedures and life support measures.
The unpredictability of patient presentations creates exciting day-to-day variation for emergency medicine practitioners. Patients present to the emergency department with undifferentiated illness, requiring the rural generalist to apply critical thinking and diagnostic skills to generate a diagnosis and commence an appropriate management plan. Rural hospitals typically have reduced access to diagnostic modalities such as laboratory and imaging services, with the rural generalist therefore needing adaptable clinical assessment skills. The fast-paced environment, where clinicians simultaneously manage multiple patients of varying acuity, is both demanding and rewarding. Rural generalists with additional training in emergency medicine enjoy the ability to perform a wide range of diagnostic and therapeutic procedures, including those related to patient resuscitation and advanced life support. Emergency medicine practitioners seldom work alone, with many rural generalists enjoying the team-based environment this specialty offers.
Both ACRRM and RACGP offer advanced skill training in emergency medicine with training to be undertaken across a minimum period of 12 months full-time equivalent at an accredited training post. The Australasian College for Emergency Medicine (ACEM) has multiple qualifications in emergency medicine which are applicable to rural generalists. Namely, these are the Emergency Medicine Certificate (EMC), the Associateship in Intermediate Emergency Medicine (IEMTP), and the Associateship in Advanced Emergency Medicine (AEMTP). ACRRM do not require completion of a formal qualification to complete an advanced skill in emergency medicine at present. RACGP require completion of the AEMTP to achieve an advanced skill in emergency medicine.
Rural generalists with additional training in mental health are expected to manage the spectrum of acute and chronic mental health presentations, predominantly in the primary care setting. The management of mental health conditions can be complex and requires the practitioner to employ an evidence-based approach. Management strategies may include cognitive behavioural therapy, medication prescription where appropriate, and recovery-orientated practice. The practitioner plays a key role in helping the patient understand their illness and empower them to combat any contributing stressors. Rural generalists who are comfortable with managing mental health issues are important in reducing the stigma of mental health in rural and remote communities.
Both ACRRM and RACGP offer advanced skill training in mental health with training to be undertaken across a minimum period of 12 months full-time equivalent at an accredited training post. From 2024 the Royal Australian and New Zealand College of Psychiatrists (RANZCP) will offer a Certificate of Psychiatry. This is a minimum twelve-month program to enable medical practitioners in Australia to learn new skills in mental health assessment and support. It introduces foundational concepts in psychiatry, under clinical supervision by experienced psychiatrists. The aim of the Certificate is to reduce workforce pressures and improve access to skilled mental health support in the Australian community. ACRRM and RACGP do not require completion of a formal qualification to complete an advanced skill in mental health at present.
The ability to receive obstetric care close to home is an important component of rural healthcare that is cherished by growing country families. Rural generalists who have undertaken additional training in obstetrics provide perinatal care in both the hospital and primary care settings. The spectrum of care that can be provided by rural generalist obstetricians includes family planning, antenatal monitoring and routine follow-up, labour and delivery, and postnatal care. The complexity of cases that can be safely managed by a rural generalist depends on their qualification and the support services available locally (for example, a special care nursery). Obstetrics is traditionally considered a procedure-heavy specialty, but it also requires development of significant interpersonal skills, due to the multidisciplinary working environment and the need to develop trusting relationships with expectant mothers.
Both ACRRM and RACGP offer advanced skill training in obstetrics, with completion of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Associate Training Program (Advanced Procedural) (APTP) required. The obstetrics curriculum for both ACRRM and RACGP is overseen by RANZCOG. The qualification requires completing a minimum period of 12 months full-time equivalent at an accredited training post along with a logbook, workplace-based assessments, upskilling workshops, and an examination. This advanced skill is referred to as ‘Obstetrics and Gynaecology’ with ACRRM and ‘Obstetrics’ with RACGP.
Rural generalists with additional training in paediatrics are expected to manage a variety of neonatal, paediatric, and adolescent presentations, including both acute and chronic pathologies and developmental paediatrics. When caring for young patients, considerable skill is required to manage the concerns and expectations of the child’s caretaker/s. Additionally, it is important to develop communication skills that can be tailored to suit a child’s level of development.
Aboriginal and Torres Strait Islander children are at higher risk of certain diseases, and a rural generalist with additional training in paediatrics is expected to be comfortable with the prevention and active management of these conditions. Examples of pathologies over-represented in rural and remote First Nations children include acute rheumatic fever/rheumatic heart disease, chronic suppurative otitis media, and scabies/impetigo.
Both ACRRM and RACGP offer advanced skill training in paediatrics with training to be undertaken across a minimum period of 12 months full-time equivalent at an accredited training post. Trainees must achieve the minimum standard for a series of assessments, and attendance at courses such as advanced paediatric life support, neonatal resuscitation, and child protection. Trainees may elect to undertake the Graduate Diploma in Child Health from The Sydney Children’s Hospitals Network, although this is not currently a mandatory requirement to achieve fellowship. This advanced skill is referred to as ‘Paediatrics’ with ACRRM and ‘Child Health’ with RACGP.
Receiving end of life care close to home is an important component of holistic healthcare delivery in rural and remote Western Australia. Palliative care is an area of medicine aimed at improving quality of life in patients with a life-limiting illness. Managing physical symptoms such as pain is mainstay practice, however a palliative care practitioner’s scope also extends to managing psychosocial and spiritual issues. Continuity of care is critical for building therapeutic relationships with both the patient and their support network. As the Australian population ages, the demand for end-of-life care services will continue to rise, and primary care practitioners will play an essential role in service provision.
Completing additional training in palliative care enables the rural generalist to develop therapeutic and supportive relationships with patients in often challenging circumstances, working within a multidisciplinary team to manage symptoms and address common barriers to communication. Delivering these skills can vary in location from hospital and hospice settings to residential care facilities or at the patient’s home. Rural generalists must have the ability to be dynamic with their service delivery, as hospice and other support services are not readily available in much of rural and remote Western Australia.
Both ACRRM and RACGP offer advanced skill training in palliative care with training to be undertaken across a minimum period of 12 months full-time equivalent at an accredited training post. Trainees may elect to undertake the Clinical Foundation in Palliative Medicine from the Royal Australasian College of Physicians, although this is not currently a mandatory requirement to achieve fellowship.
Rural generalists with additional training in population health are essential for reducing the health disparities experienced by Australians living in rural and remote communities. Rural generalists are important community advocates, ensuring essential healthcare services and innovations are delivered locally. Due to their understanding of the nuances of rural life, including important cultural and social considerations, rural generalists are in a unique position to contribute meaningfully to population health initiatives and policy.
Additional training in population health will equip the rural generalist with the skills, knowledge, and professional networks to manage many aspects of population health. Preventative health and health promotion strategies is a core component of the work, with rural generalists contributing to both the planning and implementation stages, in collaboration with the local community. This is particularly important given the higher rates of smoking, obesity, and excessive alcohol consumption in rural and remote areas*. Important preventative health strategies a rural generalist manages in their community include immunisation, sun safety, and screening programs for conditions such as breast and bowel cancer. The prevention and management of infectious disease outbreaks is critical in rural areas, as local health services can quickly become overwhelmed by high patient loads. Additional training covers important concepts of infectious disease management including outbreak identification, control measures, and education campaigns. Practitioners with population health expertise are also key members of disaster planning initiatives, and if required, implementation of strategies during disaster situations.
ACRRM is currently the only general practice training college offering advanced skill training in population health with training to be undertaken across a minimum period of 12 months full-time equivalent at an accredited training post.
Due to the geographical vastness of Western Australia, there are many isolated communities who rely on remote medicine services. The provision of medical care in remote settings is complex and often requires a degree of creativity and adaptability by the practitioner due to the lack of local infrastructure. Remote medicine practitioners must be resourceful and develop strategies to ensure longevity whilst working in isolation. Thankfully the development of a Telehealth service in Western Australia means support is always available; however, rural generalists still require a diverse skill set to provide optimal patient care in remote areas. Many rural generalists also assist with the provision of Telehealth services due to their unique understanding of the limitations faced by remote practitioners.
Remote medicine practitioners become important advocates for their community. Due to their unique understanding of local social and cultural nuances, remote rural generalists can contribute meaningfully to public health initiatives and campaign for appropriate local healthcare resources. Remote medical practitioners also play a key role in optimising environmental and occupational factors that influence the health of their community.
Remote medical practitioners play a key role in all stages of the aeromedical retrieval of patients. Aeromedical retrieval involves transferring a patient from one area to another to facilitate the provision of emergency healthcare. Typically, patients are moved to a larger rural hospital or metropolitan centre as their original location was not equipped to manage their care, often due to a lack of specialised services. Aeromedical retrieval is a logistically complex and costly operation, and therefore remote medicine practitioners need to utilise this resource wisely. The Royal Flying Doctor Service provides aeromedical retrieval services in Western Australia and employs many rural generalists due to their resourcefulness and clinical courage.
ACRRM is currently the only general practice training college offering advanced skill training in remote medicine with training to be undertaken across a minimum period of 12 months full-time equivalent at an accredited training post.
In small rural towns, the general practitioner is less likely to have access to the range of human and material resources that are available in metropolitan areas. The general practitioner will also deal with a range of emergencies, illnesses and conditions that commonly occur in rural and remote areas, for which additional support is unlikely to be available. By undertaking an advanced skill in small town rural general practice, candidates will develop the knowledge, skills and confidence to address their unique rural challenges, provide high-quality healthcare to their community, and be an advisory resource to local health service providers. A long-term outcome of this will be improved equity of access to skilled practitioners and better healthcare for rural Western Australians.
RACGP is currently the only general practice training college offering advanced skill training in small town rural general practice with training to be undertaken across a minimum period of 12 months full-time equivalent at an accredited training post.
Rural and remote Western Australians can be disadvantaged due to a lack of local surgical services and are often required to travel to larger centres for both emergency and elective care. Unlike metropolitan surgeons who are often confined to a single specialisation, surgically trained rural generalists are equipped to manage a variety of surgical presentations. Training includes components of general surgery, orthopaedics, gynaecology, genitourinary, and wound management. Additional training in performing endoscopy (colonoscopy and gastroscopy) is also within scope, with provides significant screening and diagnostic value to the local healthcare service.
Road trauma is sadly not uncommon in country Western Australia, and rural generalists with further training in surgery are often called upon to assist with trauma patient stabilisation, including damage-control surgery. Although surgery is a procedure heavy specialty, other important components of care include peri-operative patient management, such as performing appropriate investigations and both prevention and management of complications.
Both ACRRM and RACGP offer advanced skill training in surgery with training to be undertaken at an accredited training post. The minimum length of training required varies between the two general practice training colleges, with ACRRM mandating a minimum period of 24 months full-time equivalent and RACGP mandating a minimum period of 12 months full-time equivalent. Additional training requirements include completing a case logbook and assessments of various formats.
