Frequently asked questions about the DRGA

Rural generalist practitioners with advanced training in anaesthesia play vital roles in providing life-saving services to patients in many rural and remote communities across Australia. Our colleges are committed to providing rural generalists with appropriate training, assessment and continuing professional development (CPD) opportunities to support them to provide safe and high quality care.

In 1994 the Australian and New Zealand College of Anaesthetists (ANZCA) and the Royal Australian College of General Practitioners (RACGP) established the Joint Consultative Committee on Anaesthesia (JCCA), with the Australian College of Rural and Remote Medicine (ACRRM) joining in 1998 to form a tripartite committee.

The JCCA has done an incredible job of supervising and examining rural generalist anaesthetists since 1994. While there has been continuous improvement of the existing GP anaesthesia program, there has been a desire by the three colleges to reform the program to a more contemporary education model with a more formal recognition of the scope of training and assessment that is attained through the program. In 2015 the three colleges commenced discussions to develop a Diploma of Rural Generalist Anaesthesia (DipRGA) which will replace the JCCA in 2023.

The DipRGA is a contemporary diploma using up to date educational methods designed to address this lack of standardised training so that jurisdictional credentialing bodies and rural patients can be assured of a minimum standard of quality anaesthesia care by diploma holders. The DipRGA is a fit-for-purpose, Australian Medical Council accreditable qualification focussed on delivering a quality, standardised level of care for rural and remote Australians.

The Diploma of Rural Generalist Anaesthesia (DipRGA) will commence at the beginning of the 2023 hospital employment year.

The diploma will primarily be available to rural generalist registrars seeking formal training and certification in anaesthesia who are enrolled in the fellowship of the ACRRM training program and/or the RACGP fellowship of advanced rural general practice training program.

The DipRGA may also be applicable to those who have gained fellowship with ACRRM or fellowship of RACGP with an additional fellowship of advanced rural general practice and wish to gain an additional qualification in anaesthesia.

DipRGA trainees are employed by individual hospitals into rural generalist anaesthesia positions, with support from ACRRM and/or RACGP (as per the previous JCCA process). If you are interested in undertaking the DipRGA please contact your primary college (ACRRM or RACGP) for advice on available training positions and application processes.

Diploma of Rural Generalist Anaesthesia (DipRGA) supervisors of training will provide mentoring and support of trainees in the workplace. ANZCA will administer the program under the governance of the Tripartite Committee of Rural Generalist Anaesthesia (TC-RGA) and ANZCA Council. DipRGA policies, procedures and regulations identify points where a trainee’s primary college may also become involved to provide additional support.

If you have a query about the new Diploma of Rural Generalist Anaesthesia that is not answered here, please email drga@anzca.edu.au.

To register for diploma of rural generalist anaesthesia training, applicants must:

1. Be registered for training with the RACGP or ACRRM programs and  have completed at least 1 year of primary fellowship training  OR have completed their fellowship with RACGP or ACRRM.

2. Have obtained a position approved for rural generalist anaesthesia training; and

3. Have completed an accredited Advanced Life Support 2 (ALS-2) course within 52 calendar weeks prior to commencing diploma of rural generalist anaesthesia training. In exceptional circumstances where you cannot complete the ALS requirement before commencing RGA training, please contact us

Selection of trainees varies across Australia. ANZCA does not appoint trainees into accredited training positions.  If you are interested in the completing the Rural Generalist Anaesthesia Training Program, please contact your primary college (ACRRM or RACGP) for advice on available training positions and application processes.

Yes, you can. Prerequisites and recommended prelearning are below:
To register for diploma of rural generalist anaesthesia training, applicants must:

1. Be registered for training with the RACGP or ACRRM programs and have completed at least one year of primary fellowship training (unless extenuating circumstances) OR have completed their fellowship with RACGP or ACRRM; and
2. Have obtained a position approved for rural generalist anaesthesia training; and           
3. Have completed an accredited Advanced Life Support 2 (ALS-2) course within 52 calendar weeks prior to commencing rural generalist anaesthesia training.

Recommended Pre-Learning
Ideally, the Training progam will be completed toward the end of primary fellowship training or post fellowship to ensure currency of skills continues into specialist practice. Completing the pre-learning below will provide an adequate an adequate foundation in critical care, paediatrics and rural and remote practice prior to commencing RGA training:

• Experience in rural generalist practice.  
• Knowledge and skills in managing paediatric patients (refer to RACGP or ACRRM primary fellowship requirements).  
• Knowledge and skills in the management of critically ill patients, which may include: 
  ​10 weeks FTE clinical experience in intensive care medicine; or  
  10 weeks FTE clinical experience in emergency medicine and completion of a course which covers essential and fundamental aspects of Intensive Care; or
  A combination of clinical experience and education which demonstrates achievement of intensive care medicine learning. 

Trainees who have not completed recommended pre-learning may find completing the DipRGA within 12 months more challenging. 

ANZCA is responsible for the clinical standards in the diploma curriculum, while ACRRM and RACGP are responsible for standards and requirements for their respective rural generalist fellowship programs

The Diploma of Rural Generalist Anaesthesia is modelled on the ANZCA curriculum and builds from the relevant core curricula of the ACRRM and RACGP fellowship programs for rural generalist practice.  It consists of three core sections:

1. Rural generalist anaesthesia roles in practice.
This defines trainee behaviours as they pertain to anaesthesia and perioperative medicine:

1. Medical expert.
2. Communicator.
3. Collaborator.
4. Leader and manager.
5. Health advocate.
6. Scholar.
7. Professional.

2. Clinical fundamentals.
Define the fundamental specialty knowledge and skills of anaesthetists applicable across all areas of practice:

1. Airway management.
2. General anaesthesia and sedation.
3. Regional and local anaesthesia.
4.  Perioperative medicine.
5. Pain medicine
6. Resuscitation, trauma and crises management.
7. Safety and quality in anaesthetic practice.

 3. Specialised study units.
Define specialised knowledge and skills in paediatrics and obstetric anaesthesia and analgesia.

The curriculum can be viewed or downloaded under the Course content and structure tab of this webpage.

Not all EPAs will need to be completed in order.

However EPA 2 - Obstetric Epidural Analgesia, does need to be completed before EPA 7 - Obstetric Analgesia and Anaesthesia. These are the only two EPAs that must be done in sequence. So while the EPAs do not necessarily need to be completed sequentially it’s likely that the paediatric and obstetric EPAs will be completed later in training and pain medicine, perioperative assessment and epidural analgesia EPA’s will be completed earlier in training. EPAs 1 - 4 must be completed, and EPAs 5 - 7 commenced to be eligible to sit for the DRGA Standardised Structured Scenario-based assessment (DRGA-SSSA)  

The following courses must be completed as pre-requisites or as part of the Diploma of Rural Generalist Anaesthesia (DipRGA) training program:

• An advanced life support (ALS-2) course or equivalent (where competency in resuscitation and defibrillation is assessed) must be completed in the 52 weeks prior to entering RGA training.
• A Can’t Intubate, Can’t Oxygenate (CICO) course or equivalent must be completed during the DipRGA, prior to the completion of EPA 3.
• A neonatal resuscitation course or equivalent must be completed during the DipRGA, prior to the completion of EPA 7
• A paediatric life support course or equivalent must be completed during the DipRGA, prior to the completion of EPA 6
• Trainees must complete the online Perioperative Anaphylaxis Response course, available through ANZCA’s Networks, prior to the completion of EPA 5. Alternatively, trainees may complete an ANZCA Anaphylaxis practical simulation session or workshop that has been recognised as a valid activity for satisfying the CPD requirement for the management of anaphylaxis.

The minimum duration to complete the diploma is 52 weeks FTE anaesthesia time (including up to 8 weeks leave). Maximum duration for completion is two years.

Requests for extension of training time beyond two years will be considered on a case by case basis.

The exam towards the end of training is just part of a suite of assessment and trainees need to successfully complete their workplace-based assessments (WBAs) as well as the exams. The DRGA Standardised Structured Scenario-based assessment (DRGA-SSSA)  will occur towards the end of training and it is likely that the candidates will participate in that standardised assessment from the areas where they are working and examiners will be in a centralised centre. The exam will be delivered to the trainees virtually but the examiners will be together in a centre.  

The faculty of examiners will be coordinated by the DipRGA Examination Committee and is expected to include FANZCAs and rural generalist anaesthetists.

Once you have been registered as an RGA trainee with ANZCA, we will set up your access to the training ePortfolio. You will then receive an email from ANZCA with a link to the ePortfolio, your user ID, and a temporary password to gain access to the ePortfolio.

You should change your password the first time that you successfully log in.

Please send your enquiries to drga@anzca.edu.au .
 

We are currently working on a project for Single Sign On. Until that project is finalised you can change your password by using the ‘forgot password’ feature on the login page.
 

Any changes to your profile must be done by the RGA training team. Please send any change requests to drga@anzca.edu.au .
 

Yes, there are separate user guides for trainees and supervisors:

• DipRGA Trainee ePortfolio user guide
• DipRGA SOT ePortfolio user guide

The graduate outcomes for the DipRGA will be similar to the JCCA. However unlike the JCCA, where graduate outcomes can vary, particularly in paediatrics and obstetrics, all graduate outcomes for the DipRGA will be the same. In paediatrics, all graduates will be certified to anaesthetise children 5 years and over. In obstetrics all graduates will be certified epidural competent.

The primary aim of the Diploma of Rural Generalist Anaesthesia is to provide rural generalists with the knowledge, skills and professional attributes necessary for anaesthesia practice in rural communities so priority will be given to training in regional and rural contexts wherever possible. Like JCCA training, there will be no geographic restrictions on either the training posts or subsequent practise locations for rural generalist anaesthetists.   

Ultimately it is up to credentialing committees, including those of metropolitan hospitals, to decide whether they will recognise a Diploma of Rural Generalist Anaesthesia (DipRGA) for their particular service. The intended purpose of the DipRGA is to train people to work in the context of rural and remote Australia.

No. There will be volume of practice (VOP) requirements for epidural analgesia and paediatric cases however these VOP requirements are similar to those in the current JCCA training and able to be completed in a one-year diploma.

CPD requirements for holders of the Diploma of Rural Generalist Anaesthesia are currently being considered, however they are likely to be similar to the current JCCA requirements.

The Diploma of Rural Generalist Anaesthesia will provide training to produce graduates who can deliver safe anaesthesia and perioperative care in rural and remote settings for paediatric patients 5 years and over (and classed as ASA 1, 2 or stable 3 undergoing elective surgery).

An advanced certificate in paediatric anaesthesia for the 3-5 year old age group is being developed. The certificate can be completed subsequent to the DipRGA and will be available in 2024.

All providers of anaesthesia for children should be guided by ANZCA’s PG29(A) Guideline for the provision of anaesthesia care to children.

There is always crossover both ways between ANZCA trainees deciding to go into rural generalist practice and practising as rural generalist anaesthetists and some rural generalist anaesthetists that decide to go across into ANZCA training. For those that are currently training as rural generalist anaesthetists or complete the diploma of rural generalist anaesthesia and then decide that they want to go on to anaesthesia training, they will need to apply though the regular RPL process available to all ANZCA trainees and potential trainees.

It is not the intention of the Diploma of Rural Generalist Anaesthesia (DipRGA) that it becomes a pathway for ANZCA training. The purpose of the DipRGA is to provide advanced skills in anaesthesia training to rural GPs.

Similarly, for ANZCA trainees who decide that they no longer want to complete the anaesthesia training and want to transition into the DipRGA and provide rural anaesthesia, there will be some recognition of prior learning in accordance with the DipRGA recognition of prior learning and experience requirements.

Currently, to be employed as a rural generalist anaesthetist you need to provide your hospital’s credentialing committee with evidence of appropriate training and experience in anaesthetic practice. The most common evidence of rural generalist anaesthesia training at present is the JCCA letter of satisfactory completion of training. It is anticipated that if you have satisfactorily completed JCCA training and that this is currently the requirement that is recognised by your credentialing and scope of practice committee, then you would be able to continue to use that as evidence of a appropriate training and experience in anaesthetic practice.

It is anticipated that in the immediate future credentialing committees will continue to recognise similar evidence of training and experience in anaesthetic practice as they have in the past.

Applications for the grandparenting will open 29 August 2022. Please monitor this FAQs page and communication from your primary colleges for information as it becomes available.

Holders of a JCCA letter of satisfactory completion of training will be eligible to apply to be awarded the Diploma of Rural Generalist Anaesthesia through the grandparenting process.

To be eligible to apply for grandparenting an applicant must:

• Be current fellows of ACRRM or RACGP.
• Hold a JCCA letter of satisfactory completion of training or a JCCA statement of equivalence.
• Be credentialled to practice anaesthesia in a rural environment.
• Demonstrate a commitment to rural anaesthesia by recent rural anaesthesia practice.
• Have current anaesthesia-relevant CPD.

The intent of this requirement is to include rural generalist anaesthetists providing anaesthesia services to rural areas. Rural generalist anaesthetists living and working in a rural area should easily meet this criteria.

However it is appreciated that some rural generalist anaesthetists may not live or work full-time in rural areas but still provide rural anaesthesia services.

It is impossible to outline every possible scenario so the grandparenting subcommittee will assess these less straightforward scenarios on a case-by-case basis.

As a guide however, the subcommittee will be looking for a minimum of 12 weeks (full-time equivalent) service in a rural location per year for each of the preceding two years. The 12 weeks does not need to be in a single block and may be spread over the year.

“Rural” is defined as Modified Monash Model (MMM) locations 3 to 7.

“Service” would generally mean rural generalist service which includes some anaesthesia services – that is, services requiring a rural generalist anaesthesia skillset as compared to a rural generalist without advanced skills training in anaesthesia.

Many rural generalist anaesthesia services are obvious (for example lower uterine caesarean section (LUCS)) but there are less clear areas. For example, being the rural generalist anaesthetist that other rural generalists in town call in to help with difficult sedations or intubations in ED, critical care, retrieval work.

The guiding principle will be if the services being provided require a trained rural generalist anaesthetist as opposed to those services provided by rural generalists without advanced skills training in anaesthesia. 

The amount of anaesthesia services provided is not important for grandparenting. There is no minimum amount. If you can demonstrate a commitment to rural generalist service (i.e. 12 weeks FTE per year) then so long as you are providing some anaesthesia services in a rural location you should meet this requirement. 

There will be discretion applied in how commitment to rural practice is assessed. The subcommittee will be looking for a demonstration of rural commitment rather than the absolute time or the amount of anaesthesia services provided. If the subcommittee assess the applicant is committed to providing rural generalist services which includes some anaesthesia services they should meet this criteria.

Currently practising rural generalist anaesthetists without a JCCA have the following three options:

1) Apply for RPLE towards to the RGA training program.
This will require meeting all requirements of DipRGA competencies including paediatrics and epidurals. Credit will be awarded for past training and experience but this will usually result in some training time required and always result in passing the DRGA Standardised Structured Scenario-based assessment (DRGA-SSSA).

2) Continue practicing as previously with no JCCA letter of satisfactory completion of training or statement of equivalence or DipRGA
Currently, to be employed as a rural generalist anaesthetist you need to provide your hospital’s credentialing committee with evidence of appropriate training and experience in anaesthetic practice.

It is anticipated that in the immediate future credentialing committees will continue to recognise similar evidence of training and experience in anaesthetic practice as they have in the past.

No. The overall aim of the new diploma is to enhance the quality and range of anaesthesia services available to rural communities.

Currently, to be employed as a rural generalist anaesthetist you need to provide your hospital’s credentialing committee with evidence of appropriate training and experience in anaesthetic practice. The most common evidence of rural generalist anaesthesia training at present is the JCCA letter of satisfactory completion of training however some rural generalist anaesthetists are credentialled based on other anaesthesia training and experience.

It is anticipated that credentialing committees will continue to recognise similar evidence of training and experience in anaesthetic practice as they have in the past.

All new DipRGA graduates will be competent in the provision of epidural analgesia. It will be the professional responsibility of individual rural generalist anaesthetists to ensure they have adequate training and ongoing experience when providing an epidural service following their grandparenting into the DipRGA.

Applications for grandparenting will be open until 31 December 2024.

Given the changes to CPD requirements introduced by the Medical Board of Australia, the requirements for the Diploma of Rural Generalist Anaesthesia (DipRGA) CPD are still being considered. It is likely DipRGA CPD will be consistent with the current JCCA CPD arrangements with requirements for anaesthesia-specific CPD activities to be completed through the preferred CPD Home. There will be no requirement for holders of the DipRGA to join ANZCA’s CPD program (but they will have the option to join, as per the current non-fellow pathway).

Sites currently accredited to deliver the JCCA will be extended and accredited to deliver the Diploma of Rural Generalist Anaesthesia (DipRGA) for an additional two years until the end of 2024. In the interim, an accreditation process and standards will be developed for ongoing accreditation of sites delivering the DipRGA and used for new sites and reaccreditation after 2024.

For a list of accredited training sites please click here.

Training courses and/or webinars will be developed to explain the new requirements for diploma supervisors. It is anticipated these sessions will commence in October 2023.

Supervisors of training must be a fellow of ANZCA, ACRRM or RACGP and work at a site accredited to deliver DipRGA training. Supervisor of training responsibilities are currently being developed for inclusion in the DipRGA handbook and regulations.

Yes. If the trainees are in a centre where there are only FANZCAs and no rural generalist anaesthetists, then we would strongly encourage the trainee to have a rural generalist  anaesthetist mentor, ideally in a hospital that is linked to that tertiary centre to gain an understanding of rural context.

The Tripartite Committee of Rural Generalist Anaesthesia is working with the JCCA committee to determine the transition arrangements for current trainees who have not completed their JCCA by January 2023. It is likely that the JCCA governance arrangement will remain in place until most current JCCA candidates finish their training.

Trainees that haven’t completed their JCCA training when these governance arrangements end will be managed on a case-by-case basis during the transition period.

The Tripartite Committee of Rural Generalist Anaesthesia (TC-RGA) has recommended that rural generalist registrars wishing to use their Diploma of Rural Generalist Anaesthesia training and experience to provide rural generalist anaesthesia prior to being fellowed with either RACGP or ACRRM apply yearly to have a letter of support provided by the TC-RGA that they can show to relevant credentialing committees to enable them to provide anaesthesia while completing fellowship requirements.

Yes. The overall aim of the new diploma is to enhance the quality and range of anaesthesia services available to rural communities. Satisfactory completion of JCCA training will continue to be recognised after the introduction of the Diploma of Rural Generalist Anaesthesia and existing rural generalist anaesthetists will be allowed to practice with in-scope anaesthesia procedures subject to their usual local clinical privileging arrangements.

No, there is no ongoing annual fee for holders of the Diploma of Rural Generalist Anaesthesia.

The Diploma of Rural Generalist Anaesthesia is a diploma program only and will recommend minimum ongoing CPD. However, as per recent Australian Medical Council changes, there is no requirement to register with ANZCA as your CPD home.

 

	Fee	GST	Total
Application fee	$450	$45	$495
Training fee	$1,925	$0 (no GST)	$1,925
Extended training fee	Calculated at the percentage of additional training time in number of weeks per year in relation to the training
Grandparenting	$300	$30	$330
Recognition of Prior Learning (RPL)	$1,000	$100	$1,100
Diploma / completion fee	$400	$40	$440

Exam fees

	Fee
MCQ exam	$1,430
DRGA Standardised Structured Scenario-based assessment (DRGASSS)	$4,345

There are two components to the cost, a training fee and an exam fee. The training fee covers the administration of the program at ANZCA and supports things such as access to the library and the electronic training platform used by trainees. The exam fees covers the running of the multiple choice exam and the DipRGA Standardised Structured Scenario-based assessment (DRGASSS).

It is acknowledged that these costs are significantly higher than those associated with the JCCA. The JCCA has done an incredible job of supervising and examining rural generalist anaesthetists since 1994. The DipRGA is a contemporary diploma using up to date educational methods that will provide asurance to jurisdictional credentialing bodies and rural patients of a minimum standard of quality anaesthesia care by diploma holders. The DipRGA is a fit-for-purpose, Australian Medical Council accreditable qualification focussed on delivering a quality, standardised level of care for rural and remote Australians.

The costs of completing the Diploma of Rural Generalist Anaesthesia are similar to those of comparable diploma programs offered by the Australasian College for Emergency Medicine (ACEM) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).

Training and associated fees

	Fee	GST	Total
Application fee	$450	$45	$495
Training fee	$1,925	$0 (no GST)	$1,925
Extended training fee	Calculated at the percentage of additional training time in number of weeks per year in relation to the training
Grandparenting	$300	$30	$330
Recognition of Prior Learning (RPL)	$1,000	$100	$1,100
Diploma / completion fee	$400	$40	$440

Exam fees

	Fee
MCQ exam	$1,430
DipRGA Standardised Structured Scenario-based assessment (DRGASSS)	$4,345

Firstly, in those situations we will be supporting the trainee to achieve those competencies because they are a requirement of the Diploma of Rural Generalist Anaesthesia (DipRGA). Next, an option may be that the trainee would benefit from extended training time and may need to go to a paediatric or obstetric centre so that they can complete the volume of practice and gain the confidence they need in those areas of practice.

The DipRGA has the same graduate outcomes for all graduates so if the trainee was unable to complete those two components of the curriculum then they would be unable to be awarded the diploma.

Yes but these will depend on employment arrangements. The Diploma of Rural Generalist Anaesthesia can be completed in two years at 0.5 FTE.

All training requirements must be completed within two calendar years of the date of commencement of training. Any time spent in interrupted training will not count towards the two years to complete. Regulations are currently being confirmed however it is anticipated that a period of interruption greater than 13 weeks will require a re-entry to practice period.

All of the training sites that are currently accredited to provide JCCA training will be accredited to provide Diploma of Rural Generalist Anaesthesia training. The requirements around obstetrics and paediatrics may be problematic for some of those sites and so the Tripartite Committee of Rural Generalist Anaesthesia will need to monitor that in 2023 as the diploma is introduced to make sure that trainees are getting experience in those two areas.

Diploma of Rural Generalist Anaesthesia trainees will enrol with ANZCA so they will have access to the same college library services that ANZCA trainees have. They will also have access to a learning platform similar to ANZCA trainees. So there will be more standardised and nationally available resources for diploma trainees which is not currently available with the JCCA. Further, we are working to further develop those resources for diploma trainees and they will most likely be available through the ANZCA library.