Dear Editor,

The Winter issue of O&G Magazine focused on Lifelong Learning. We were interested to read this collection of interesting articles. In particular, the features from Dr. Judith Gardiner on GPO upskilling¹ and Dr Aggie Kujawa² on clinical attachments for RANZCOG diplomates, echo what we learned in a recent evaluation of Rural Generalist Advanced Obstetric Training in Victoria.³

While the RANZCOG requirements of the Advanced Diploma provide competence to practice independently, our interviews with former trainees, supervisors, and key informants highlighted the clear difference between competence and the confidence to do so, alone, in the bush, at night. This crucial aspect of General Practice Obstetrician/Rural generalist Obstetrician (GPO/RGO) practice, expressed so poignantly by Dr Kujawa, was a recurring theme in our project.

Our participants’ ideas about improving this competence-confidence mismatch reinforce what is expressed by Dr Gardiner and Dr Kujawa. These are in the areas of training time; skills consolidation; skills maintenance; and ongoing support and networking. We use the terms skills maintenance and skills consolidation rather than “upskilling”, as we feel it more accurately describes what is required by the GPO/RGOs.

As a result of this project, we identified several action points that could contribute to the successful training and maintenance of a competent and confident GPO/RGO workforce. These findings and recommendations were presented to a forum of stakeholders on 1 April 2022 including trainees, supervisors, GPO/RGOs, and representatives from VRGP, ACRRM, RACGP, RANZCOG and the Department of Health. The recommendations were considered one by one by the group, and the resulting fruitful discussions gave very constructive feedback which has helped us revise and improve the action points.

Regarding the areas of training time; skills consolidation; skills maintenance; and ongoing networking and support, the following recommendations were made.

• Within each training post clarify and formalise the flexibility of completing the training full-time or part-time, balancing training vs service delivery, with flexible entry points and recognition of training time by RACGP and ACRRM.
• Quarantine and fund Consolidation of Skills posts; funding to follow the trainee to enable their identified learning needs with a robust mechanism to ensure funding meets the training plan of the trainee.
• Promote regional hospital engagement with GPO/RGOs to facilitate funded opportunities to pursue skills maintenance as per FRANZCOG accreditation requirements, apart from locum coverage.
• Increase awareness and support of the GPO/RGO career choice via multiple mediums and stakeholders, with ongoing and funded networking opportunities between GPO/RGOs, specialists, medical students, midwives, consumers, and health services.

We think these action points reinforce the arguments made in Dr Gardiner’s and Dr Kujawa’s articles and will continue to be pursued. Our goal is the same – to help ensure the ongoing viability of high-quality maternity services for all women in Australia.

Submitted by Dr Duncan Howard, Ms Sara Newton, Ms Malia Lardelli and Dr Graham Slaney

1. Dr Judith Gardiner. “GPO upskilling”. O&G Magazine, Vol 24 No 2 Winter 2022
2. Dr. Aggie Kujawa. “Clinical attachments for RANZCOG Diplomates”. O&G Magazine, Vol 24 No 2, Winter 2022.
3. Sara Newton, Duncan Howard, Malia Lardelli, Graham Slaney. “VRGP State-wide Evaluation of Rural Generalist Advanced Obstetrics Training”. Project funded through the VRGP by the Department of Health. June 2022.