ASSESSMENT OF OVERSEAS TRAINED PHYSICIANS & PAEDIATRICIANS (NEW ZEALAND) POLICY EDU-OTP-3.3. Education: Overseas Trained Physicians

Transcription

1 POLICY DOCUMENT ASSESSMENT OF OVERSEAS TRAINED PHYSICIANS & PAEDIATRICIANS (NEW ZEALAND) POLICY Policy Number: Policy Area: Policy Author: EDU-OTP-3.3 Education: Overseas Trained Physicians Expert Advisory Group, Overseas Trained Physicians Contact Officer: Executive Officer Training & Assessment (NZ) Approval Details: College Education Committee 4 December 2009 Amended October 2010, November 2011 Date Effective: December 2009 Date of Next Review: July 2012 Policy Status: Related Policies: Revised Policy (Supersedes EDU-OTP-3) Reconsideration, Review and Appeals Process By-Law 1. Definitions: International Medical Graduate (IMG) / Overseas-Trained Physician (OTP) The Medical Council of New Zealand (MCNZ) uses the term International Medical Graduate (IMG) for any overseas-trained doctor who has completed their undergraduate degree, or may be in the process of completing, specialist training. RACP uses the term IMG for those who have completed their undergraduate degree but not completed their specialist training. Overseas-Trained Physician (OTP) is the term used by RACP for physicians and paediatricians who have completed their specialist training abroad. When clinicians are being assessed for Vocational Registration they are called OTPs. 2. Overview: 2.1. As the authority on professional standards for physicians and paediatricians in New Zealand, the College acts as a Branch Advisory Body (BAB) to the Medical Council of New Zealand (MCNZ) and advises on the suitability for registration of overseas trained physicians/paediatricians (OTPs). The College assessment process begins following referral of eligible candidates from the MCNZ This policy defines the framework used by the Royal Australasian College of Physicians (including its Divisions, Faculties and Chapters) for determining if the training, qualifications and experience of an OTP are comparable to that of a New Zealand-trained physician/paediatrician. The policy details the assessment process and possible outcomes including additional assessment requirements for OTP applicants for vocational registration. 3. Background and Purpose: The College, MCNZ and the New Zealand public require an open and fair process for the assessment of OTPs that maintains standards of medical practice and protects the public This policy has been developed in accordance with the directives and expected assessment standards defined by the MCNZ. Education Policy: Assessment of Overseas Trained Physicians (New Zealand) Policy (November 2011) Page 1 of 8

2 3.2. The purpose of this policy is to clarify the assessment framework, including possible outcomes and requirements for OTPs and to ensure transparency and consistency in approach to all OTP assessments undertaken by the College. 4. The Policy: Please refer to Appendix 1 for a flowchart of the OTP Assessment Process The Assessment Process Each application for vocational registration by an OTP, including supporting documentation and fees, is lodged with MCNZ then forwarded to the College for advice. When considering applications for vocational registration, MCNZ and the College must ensure that all relevant information regarding an applicant s: qualifications, training and experience are given full and proper consideration For OTPs Applying for Vocational Registration Who are Not Currently in New Zealand. If an OTP is not currently in New Zealand, MCNZ will request preliminary advice from the College based on the information provided in the application, CV and referee reports On receipt of the relevant information, if the applicant s qualifications, training and experience are deemed insufficient to warrant vocational registration, the applicant is advised of this as soon as possible by MCNZ. This avoids OTPs being inconvenienced by travelling to New Zealand for an interview if vocational registration is unlikely. If registration is considered likely, this will give applicants and potential employers reassurance Preliminary advice is sought from the relevant Specialist Advisory Committee (SAC), Specialty Training Committee (STC), or Education Committee (EC). If necessary, the applicant s information will go to two SAC committees one will be the SAC for General Medicine or General Paediatrics, and the other will be the SAC for the relevant subspecialty e.g., Geriatric Medicine, Gastroenterology. Advice from the Chair(s) of the SAC(s) is then forwarded to the lead Adult Medicine or Paediatric Fellow of the NZ Overseas-Trained Physician (OTP) Assessment Committee The MCNZ RGR5 document is signed off by the OTP Assessment Committee Chair, after consideration of the draft advice from the SAC and forwarded to MCNZ Preliminary advice is to be considered indicative only, and is not binding on the RACP. The RACP s advice can only be finalised after formal interview Request for Interview for Assessment of Eligibility for Vocational Registration For OTPs already in New Zealand or when those with positive preliminary advice arrive in New Zealand, the MCNZ will require the applicant to be interviewed by the College to assess whether the applicant is comparable to an Australasian trained physician/paediatrician The purpose of the interview is to enable the College to assess what is required of the applicant to qualify for registration within a vocational scope of practice and to advise the MCNZ accordingly. This is done by: reviewing the documentation, CV, and qualifications; determining and confirming the nature and quality of the applicant s training and experience, supervision of training and assessments undertaken; Education Policy: Assessment of Overseas Trained Physicians (New Zealand) Policy (November 2011) Page 2 of 8

3 ensuring the applicant understands the standards of competence and range of practice expected in New Zealand Interview Advice: Two representatives of the College (usually a representative from the appropriate Specialist Advisory Committee and the NZ OTP Assessment Committee) interview the applicant and their report is considered at the next meeting of the NZ OTP Assessment Committee. A recommendation is forwarded to MCNZ using an RGR5. Once a decision has been made by MCNZ, the College and applicant are advised of the outcome Options for Preliminary and Interview Advice There are four options available for the College to use when providing advice to MCNZ. One of these options is selected and where necessary, supporting statements are included in the recommendation to MCNZ Option A (Supervision Pathway) The applicant has qualifications, training and experience comparable to a medical practitioner vocationally registered in the same vocational scope. Registration within a vocational scope of practice will be appropriate after 12 months supervised practice and on receipt of satisfactory supervisors reports by the MCNZ. The College does not supervise the probationary year under this pathway but does receive copies of the supervisor reports Option B (Assessment Pathway) The applicant has qualifications, training and experience comparable to a medical practitioner vocationally registered in the same vocational scope and is expected to reach the standard of competence required for registration within a vocational scope of practice over a period of 12 months of supervised clinical experience and assessment (e.g. an exit examination may be required). The College approves posts, supervisors and receives reports. The College will advise MCNZ when the doctor is considered to have reached the standard for registration within a vocational scope of practice The New Zealand OTP Assessment Committee may recommend additional assessments such as: 1. a vocational practice assessment (VPA); or 2. the RACP written and /or clinical exam (refer item 12 for Faculty and Chapter assessments). These further assessments may be required where: it is determined that an applicant has not undertaken written and/or clinical assessments comparable to those undertaken by Australasian trainees; or it is determined that the assessment process did not include external input or a clinical component was not centrally administered; or the OTP Assessment Committee is unable to determine the comparability of the OTP s training and experience with that of an Australasian trained consultant physician/paediatrician; or an applicant has not progressed satisfactorily during the period of provisional vocational registration. These additional assessments would be stipulated by MCNZ at the commencement of the provisional registration year, or later when the applicant has not progressed satisfactorily and achieved the required standard during the period of vocational registration. Education Policy: Assessment of Overseas Trained Physicians (New Zealand) Policy (November 2011) Page 3 of 8

4 a. The period of provisional registration within a scope of practice may be extended by MCNZ where the applicant has not reached a standard comparable to that of an Australasian consultant physician/paediatrician. b. When the College is made aware of an OTP contravening its assessment requirements, including supervision or time frame requirements, or who has behaved in a way that constitutes notifiable conduct, the College is obligated to inform the MCNZ and registration authorities and College support for registration may be withdrawn Vocational Practice Assessment (VPA) The VPA, which is arranged by MCNZ, generally takes place during the second half of the year of provisional registration or during any period of the extension of that year. The VPA is undertaken by two Fellows of the College nominated by the Medical Council of New Zealand. The format of the VPA is outlined in advance and details communicated to the applicant. It usually consists of direct observation of the applicant in practice conducting a ward round and an out-patient clinic Written and/or Clinical Examinations a. The applicant is responsible for providing evidence that previous examinations completed are comparable. b. If the applicant is required to complete both the written and clinical examinations, the Written Examination must be successfully completed before the applicant is eligible to attempt the Clinical Examination. c. Applicants for specialist registration, who have not completed a comparable Written Examination as part of their training and assessment overseas, will be required to successfully complete the RACP Written Examination prior to attempting the Clinical Examination. d. A comparable written examination is one that tests knowledge base and clinical application in general medicine and subspecialty medicine. The examination must have taken place within the training programme and after completion of at least 18 months of training (post intern or pre-registration year). The written examination must be set and marked by a Board of Examiners which is external to the trainee s training environment. Examinations to enter a training programme will not be regarded as a comparable examination. e. Applicants who are required to complete the RACP Written Examination as part of their requirements for specialist registration will sit the same examination undertaken by College trainees at the completion of basic training. This examination assesses a broad range of clinical knowledge. f. Applicants for specialist registration who have not completed a comparable clinical examination as part of their specialist training programme may be required to undertake a clinical examination. g. A comparable clinical examination is regarded as one which has real patient encounters and tests candidates ability in the following areas: Comprehensive history taking including an appreciation of the patient s social and home circumstances Accuracy of physical examination Development of a diagnostic synthesis and prioritisation of issues Plan of investigation and management for the patient The clinical examination must have been conducted on patients who are unknown to the candidate and assessed by examiners who are external to the candidate s training environment. Education Policy: Assessment of Overseas Trained Physicians (New Zealand) Policy (November 2011) Page 4 of 8

5 4.5. Option C h. The RACP Clinical Examination requires candidates to undertake two (2) long cases and four (4) short cases in one day during the annual examination period (approximately June of each year). i. Applicants who are required to successfully complete the Clinical Examination must do so within their period of probationary vocational registration with the NZ Medical Council. The applicant s qualifications, training and experience are not comparable to that of a medical practitioner vocationally registered in the same vocational scope. Specific details are to be provided to MCNZ of the differences between the applicant s qualifications, training and experience and that of a medical practitioner vocationally registered in the same vocational scope Option D (only to be used where preliminary advice is being given): The College is unable to provide a recommendation on the information provided by the applicant and/or there are particular issues that need to be clarified before a recommendation can be made. A College interview with the applicant may be required in order to clarify issues or obtain more detailed information from the applicant. Specific details are to be provided about the issues that need to be clarified or additional information that is required by the College in Section Four of the MCNZ RGR5. 5. Supervised Practice: In both Options A and B, there is a period of supervised practice: 5.1. Option B: Clinical practice under supervision requires the OTP to work in a position that has been prospectively approved by the College. Applicants will be required to submit a detailed pro forma application for approval of supervisors to MCNZ who forward it to the College for approval The purpose of the period of supervision is two-fold. Firstly, it allows the OTP the opportunity to be orientated to the New Zealand health care system and their workplace. It also allows practising specialists to interact with the OTP in a clinical context to determine if he/she is performing at the level of an Australasian-trained physician/paediatrician, and to identify any areas of practice that might require improvement prior to final sign-off Practice under supervision must be: undertaken in New Zealand or Australia; prospectively approved by the College; undertaken in a position that allows independent practice at least at senior registrar, or junior consultant level All applicants must have at least two (2) supervisors who are vocationally registered and preferably Fellows of the RACP monitoring their progress throughout the period of professional supervision. The OTP nominates the supervisors once a position is found, however the RACP can provide assistance in the nomination of supervisors. It is expected that the designated supervisors meet with the OTP on a regular basis through regular informal meetings as well as more formal discussions at least monthly to discuss his/her progress and to implement remediation programmes if the need arises. A Supervisor s Report will be required to be completed by the supervisors at 3, 6, 9 and 12 months and forwarded to MCNZ who send a copy to the College Supervisors are required to make specific comments on all areas relevant to an OTP s clinical practice. Before completing the report the supervisors should confer with other medical, nursing and allied health professional staff that the OTP interacts with on a regular basis. During the period his/her performance will be assessed at the standard of a consultant physician or paediatrician Education Policy: Assessment of Overseas Trained Physicians (New Zealand) Policy (November 2011) Page 5 of 8

6 and evaluation for each period will be discussed with the OTP. In addition, the OTP will sign the report and add any additional comments prior to it being returned to MCNZ At the completion of the period MCNZ will decide whether it has been completed satisfactorily or if additional assessments are required If an OTP wishes to complete part of the supervised period in a private practice setting, it is not normally appropriate for this to make up any more than half of the time in the position (i.e. 0.5 FTE). The approval of clinical supervision undertaken in a private practice setting is subject to the approval of the NZ OTP Assessment Committee and the relevant SAC Clinical supervision can be undertaken in either a part-time or full-time capacity, although it is preferable that this is completed on a full-time basis. Part-time completion will extend the period of supervision. The purpose of supervision is to ensure that those who are reviewing the OTP have adequate exposure to the day-to-day work of the applicant. This may be broken up into separate programmes, however MCNZ needs to be assured that the supervision process has been robust and that all elements of relevant practice have been confirmed before completion of the requirement is supported All OTPs are required to complete the OTP Orientation Programme. This will involve online completion of modules based on domains of the Professional Qualities Curriculum. The orientation modules are available on the College website, 6. Participation in Continuing Professional Development (CPD) It is mandatory that applicants assessed as Option A or B demonstrate active participation in Continuing Professional Development (CPD) whilst completing the requirements for their Professional Review Period. Applicants are required to enrol in the RACP s MyCPD programme [or equivalent] at the commencement of their supervision/assessment period and must demonstrate continued involvement in the programme. Information relating to the RACP s policy for the MyCPD programme can be found at 7. Eligibility for Vocational Registration Following successful completion of all requirements for the supervision/assessment programme, MCNZ will be advised that the applicant has met the requirements for specialist registration and is recommended for recognition as a specialist. 8. Review, reconsideration and appeal against assessment outcome As MCNZ make the final decision on an OTP assessment, any appeal against that decision by the OTP would be managed by MCNZ. MCNZ may seek further comment from the College in relation to their advice. 9. Timeframe for completion of assessment outcome This will be determined by the MCNZ. 10. Monitoring and Evaluation of Assessment Framework The College will ensure that relevant stakeholders, including OTPs, will be an integral part of the monitoring and evaluation process leading to improvements in usability and increased validity and reliability of this assessment framework. 11. Legal implications: 11.1 Collection and handling of information relating to OTP assessment is managed in accordance with the College Privacy Policy which adheres to current privacy legislation (refer Privacy Policy). Education Policy: Assessment of Overseas Trained Physicians (New Zealand) Policy (November 2011) Page 6 of 8

7 11.2 All applicants are entitled to natural justice. If there is material adverse to or critical of the applicant, they will be advised of the material and given adequate opportunity to respond. 12. Chapter and Faculty differences: i. AFOEM may require successful completion of their written and practical examination undertaken by AFOEM trainees at the completion of their specialty training. ii. AFPHM may require successful completion of the Final Program Assessment undertaken by AFPHM trainees at the completion of their specialty training. No written examination required. iii. AFRM may require successful completion of their written and clinical examinations undertaken by AFRM trainees at the completion of their specialty training. iv. The Chapter of Addiction Medicine may require exit level assessments. v. The Chapter of Palliative Medicine may require exit level assessments. vi. The Chapter of Sexual Health Medicine may require an exit interview equivalent to that undertaken by trainees at the completion of the specialty training. vii. Further details on these assessments can be gained directly from the appropriate Chapter or Faculty. 13. Procedures, forms and supporting documentation: 13.1 Appendices: Appendix 1: Assessment framework flowchart Education Policy: Assessment of Overseas Trained Physicians (New Zealand) Policy (November 2011) Page 7 of 8

8 Appendix 1 RACP receives application for Vocational Scope from the MCNZ. This assessment pathway is for applicants who wish to be assessed for comparability to a New Zealand trained physician/paediatrician. Preliminary Advice Determining the suitability of an applicant for further assessment. Option A: Supervision Pathway Applicant has completed training that is deemed by the RACP to be substantially comparable to that undertaken by Australasian trained physicians/paediatricians. Each applicant must complete: An interview (as required by the NZ OTP Assessment Committee) A period of up to 12 months supervised practice Applicants are also required to participate in the RACP s MyCPD programme or equivalent to ensure Continuing Professional Development. Option B: Assessment Pathway Applicant has completed training that is deemed by the RACP to be partially comparable to that undertaken by New Zealand trained physicians/paediatricians. Each applicant must complete: An interview The Written and/or Clinical Examination or a vocational practice assessment. Examination or vocational practice assessment requirements will be determined on an individual basis depending on the applicant s training and prior assessments A period of at least 12 months supervised practice Participation in the RACP s MyCPD programme or equivalent Option C: Not Comparable The applicant has undertaken training or experience that is considered not comparable to that of an Australasian trained physician/paediatrician. The RACP recommends that applicants who have not undertaken comparable training/experience contact the MCNZ regarding other registration options. Once all requirements have been successfully completed, a recommendation will be provided to the MCNZ. Education Policy: Assessment of Overseas Trained Physicians (New Zealand) Policy (November 2011) Page 8 of 8