Introduction

Development of the Curriculum

A comprehensive Prospectus1, and a Position Paper2, both published in 1997, established the need for a curriculum and indicated the major directions for further development.

The first edition of the ACRRM Primary Curriculum was published in 1998. The second edition was published in 2003, and the third edition in 2006. Minor revisions were made to the third edition in 2009. The fourth edition (2013) resulted from a major review of both content and structure involving key stakeholders conducted between October 2009 and January 2010.

The fifth, current edition reflects continued development of the structure and content in response to developments in medical education including the shift towards competency based medical education and the work of the Australian National Rural Generalist Taskforce.

The first four editions of the Curriculum were divided into the Primary Curriculum and separate curricula for each Advanced Specialised Training discipline.

The fifth edition brings together all areas into one curriculum and is titled the Rural Generalist Curriculum.

The unique nature of Rural Generalist medicine requires a specific curriculum structure, which includes a combination of multi-specialty learning areas, general non-medical competencies, non-medical competencies specific to Rural Generalist medicine and specific focus on interactions with other specialities outside Rural Generalist medicine.

Curriculum Principles

The Curriculum is underpinned by 10 principles:

1. Grounded in professional standards

Defines the essential competencies, knowledge, skills and attributes required of General Practitioners across all working contexts in Australia. Accredited by the Australian Medical Council in the speciality of general practice.

2. Responsive to community needs

Responds to the diverse needs of the Australian population, including the health needs and priorities determined by the Australian Government, and the needs expressed by rural and remote people and communities.

3. Responsive to the rural and remote context

Focuses on the key features that define rural and remote generalist medical practice and distinguishes it from urban models of generalist medical practice. This includes working across primary and secondary care, emergency medicine, Aboriginal and Torres Strait Islander health, and independence in decision-making and models of collaboration and support across extensive geography.

4. Integrated rural pathway

Designed to create a rural career pathway through connecting with prevocational rural education and training programs and continuing post Fellowship with career development and skills maintenance. Incorporates flexible entry options and recognition of prior learning.

5. Competency-based approach

Defines competencies, knowledge, skills and attributes and incorporates flexible approaches to gaining and demonstrating competency. Fellowship standards are defined, and indicators guide progression.

6. Focus on experiential learning

Supports a constructivist teaching and learning approach, involving experience in a variety of structured placements, with guided and self-directed learning and supervision from experienced mentors and educators.

7. Relevance to practice

Content is applicable to the current and projected future demands of rural and remote generalist practice.

8. Validity, reliability and educational soundness

The Curriculum and its related assessment processes are progressive, academically rigorous, educationally sound, clinically relevant, valid, reliable, and are designed to have a positive educational impact.

9. Appropriateness and acceptability of delivery and assessment methods

Delivery and assessment methods have been designed to be appropriate and acceptable to registrars in rural and remote contexts. This is done through distance learning, flexible delivery methods and interactive approaches.

10. Contribution to improving workforce capacity

Contributes to building a skilled, confident, safe and competent Australian Rural Generalist medical workforce.

Curriculum Overview

The Curriculum is structured around eight Domains of rural and remote practice. Each domain contains a set of Competencies.

Competencies are observable abilities that require the integration of multiple Knowledge, Skills and Attributes. The competency Standards describe the Fellowship standard and indicators to achieving this standard.

37 Learning Areas detail the Knowledge, Skills and Attributes at Core Generalised and where relevant Advanced Specialised levels. There are both clinical and non-clinical Learning Areas, drawing on the roles of a doctor identified in the CanMEDs framework.

The Competency Blueprint maps the Learning Areas against the Competencies.

Domains of Rural and Remote Practice

The eight domains of rural and remote practice describe the contexts of rural and remote practice.

1. Provide expert medical care in all rural contexts: patient-centred approach, diagnosis, management and team work.

2. Provide primary care: whole patient care, longitudinal care, first point of care, undifferentiated presentations, care across lifespan, acute and chronic care and preventive activities.

3. Provide secondary medical care: inpatient management, respond to deteriorating patient, handover, safe transfer and discharge planning.

4. Respond to medical emergencies: hospital & prehospital, resource organisation, initial assessment and triage, emergency medical intervention and patient evacuation.

5. Apply a population health approach: community health assessment, population level health intervention, statutory reporting and disaster planning.

6. Work with Aboriginal, Torres Strait Islander, and other culturally diverse communities to improve health and wellbeing: strengths-based, respect and understanding

7. Practise medicine within an ethical, intellectual and professional framework: ethical practice, clinical documentation, quality and safety, professional obligations, continuous learning, leadership, teaching and research.

8. Provide safe medical care while working in geographic and professional isolation: resourcefulness, independence, flexibility, technology, professional network and extended practice.