International Medical Graduates Registration Pathways. May 2014

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1 International Medical Graduates Registration Pathways May 2014

2 Health Workforce Australia This work is Copyright. It may be reproduced in whole or part for study or training purposes. Subject to an acknowledgement of the source, reproduction for purposes other than those indicated above, or not in accordance with the provisions of the Copyright Act 1968, requires the written permission of Health Workforce Australia (HWA). Enquiries concerning this report and its reproduction should be directed to: Health Workforce Division Department of Health GPO Box 9848 Canberra ACT 2601 Suggested citation: Health Workforce Australia 2014: International Medical Graduates Registration Pathways International Medical Graduate Registration Pathways Page i

3 Contents Introduction... 1 Purpose of the paper... 1 About Health Workforce Australia The Australian Health Care System Pathways to Registration Competent Authority Pathway Standard Pathway Specialist Pathway The Royal Australian College of General Practitioners Australian College of Rural and Remote Medicine Assessment Processes for Registration Registration Limited Registration Provisional Registration General Registration Specialist Registration Health Insurance Act Appendix A - Competent Authority Pathway: Eligibility Requirements Appendix B RACGP Recognised Qualifications Appendix C ACRRM Codified List of Suitable Qualifications Abbreviations Glossary References International Medical Graduate Registration Pathways Page ii

4 Introduction Purpose of the paper The International Medical Graduates Registration Pathways report provides information about the registration pathways and associated processes for International Medical Graduates (IMGs) in Australia. About Health Workforce Australia Health Workforce Australia (HWA) is an initiative of the Council of Australian Governments (COAG), and has been established to address the challenges of proving a skilled, flexible and innovative health workforce that meets the needs of the Australian community, now and into the future. HWA was established following the development of a $1.6Bn National Partnership Agreement (NPA) on Hospital and Health Workforce Reform by the Commonwealth and State and Territory Governments in November HWA reports to Health Ministers and will operate across health and education sectors to devise solutions that integrate workforce planning, policy and reform with the necessary and complementary reforms to education and training. HWA s functions include: The provision of comprehensive, authoritative national workforce planning, policy and research advice to Ministers, Governments and key decision makers in the health and education sectors. Improving and expanding access to quality clinical education placements for health professionals in training across the public, private and non-government sectors. This will be achieved through programs that expand capacity, improve quality and other diversity in learning opportunities. This also includes a national network of simulated learning environments (SLE s) to enhance the quality, safety and efficiency of clinical training. Developing and implementing a national program of health workforce innovation and reform. This will encourage the development of new models of healthcare delivery, facilitate inter-professional practice and equip health professionals for current and emerging demands on the health care sector. Facilitating a nationally consistent approach to international recruitment of health professionals to Australia. International Medical Graduate Registration Pathways Page 1

5 1 The Australian Health Care System The Australian health care system is based on the philosophy of universal access to quality health care for Australians; as a result the health care system is extensive, complex and technically sophisticated. The structure of the health care system comprises all levels of government (Commonwealth, State/Territory and local). Services are provided publicly and privately, and funded by governments and individuals. The Australian Commonwealth Government is primarily responsible for the funding of health care, through health insurance arrangements and direct payments to the States and Territories, while the State and Territory governments are primarily responsible for the direct provision of services. The Australian Government operates universal benefits schemes, the Medicare Benefits Schedule for private medical services and the Pharmaceutical Benefits Scheme for pharmaceuticals. It also contributes to the funding of public hospitals in the States and Territories through the Australian Health Care Agreements. The Australian Health Workforce The Australian health workforce is composed of doctors, nurses and allied health professionals working across a diverse range of settings. The workforce consists primarily of Australian-trained health professionals, with an increasing number of internationally-trained health professionals. Australia is heavily reliant on international health professionals to meet workforce shortages, particularly in rural and remote Australia. Currently, IMGs make up a significant portion of the rural and remote medical workforce. International Medical Graduate Registration Pathways Page 2

6 2 Pathways to Registration In Australia, there are three pathways to registration available to IMGs. The three pathways are the Competent Authority Pathway, the Standard Pathway, and the Specialist Pathway. The most appropriate pathway for an IMG to follow is determined by the individual or by the recruiting organisation/employer, based on the IMG s qualification, skills and experience. Each pathway has a number of assessment processes that IMGs must successfully complete to be eligible for registration. The Competent Authority Pathway 1 is for eligible IMGs who seek general registration and have completed a formal examination for registration purposes or an accredited medical qualification of an institution that has been assessed and approved by the Australian Medical Council (AMC). The Standard Pathway 2 is for non-specialist IMGs who seek general registration and who do not qualify for the Competent Authority Pathway. The Specialist Pathway 3 is for IMGs seeking registration as a specialist who have completed specialist training and are recognised as a specialist in their country of training. The IMG s specialist education, training and relevant experience are assessed by the relevant specialist college against the standard required for an Australian-trained specialist in the same field of specialty practice. Under the Health Practitioner Regulation National Law Act 2009 (the National Law), as in force in each state and territory, all IMGs seeking registration in Australia are required to meet a number of standards, including providing evidence of English language proficiency 4, applying to have their medical qualifications verified by the Educational Commission for Foreign Medical Graduates International Credentials Services (EICS) 5, and undergo a criminal history check. IMGs are also required to meet certain legislative requirements under the Health Insurance Act 1973 in order to access Medicare provider numbers 6. As of the 1 July 2014 new changes to the registration pathways will be introduced. 1 Australian Medical Council. (2012). "Competent authority pathway." Retrieved 24/07/2013, from 2 Australian Medical Council. (2012). "Standard pathway." Retrieved 24/07/2013, from 3 Australian Medical Council. (2012). "Specialist pathway (specialist recognition)." Retrieved 24/07/2013, from 4 Australian Medical Council. (2013). "English language proficiency." Retrieved 24/07/2013, from 5 Australian Medical Council. (2012). "Primary source verification." Retrieved 24/07/2013, from 6 DoctorConnect. (2013). "Medicare provider number legislation " Retrieved 24/07/2013, from International Medical Graduate Registration Pathways Page 3

7 3 Competent Authority Pathway The Competent Authority Pathway (Figure 1) is for eligible IMGs who seek general registration and have completed a formal examination for registration purposes or an accredited medical qualification of an institution that has been assessed and approved by the AMC 7 (see Appendix A - Competent Authority Pathway: Eligibility Requirements). IMGs whose qualifications are determined by the AMC to be comparable under the Competent Authority Pathway are provided with an AMC Certificate of Advanced Standing 8. Following this, IMGs can apply for a job if they have not already secured one. A Pre-Employment Structured Clinical Interview (PESCI) may need to be conducted to determine an IMG s suitability for a position, in particular for general practice and primary care positions. If successful, the IMG can then apply for Limited Registration with the Medical Board of Australia (MBA) 9. Information about Limited Registration is provided under the Registration section of this document. To fulfill the requirements of General Registration under the Competent Authority Pathway, IMGs must complete a period (12 months minimum) of supervised training before receiving an AMC Certificate. The AMC Certificate allows IMGs to apply to the MBA for General Registration 10. Information about General Registration is provided under the Registration section of this document. The MBA has announced changes that will come into effect from 1 July 2014 and replace the current Competent Authority Pathway with a new process where applicants will apply directly to the MBA for registration under the provisions of Section 53(b) (for graduates of accredited United Kingdom (UK) and Irish medical courses) and Section 53 (c) (for IMGs who have passed the Professional and Linguistic Assessments Board (PLAB) test, Medical Council of Canada (MCC) licentiate examinations, the United States Medical Licensing Examination (USMLE) or the New Zealand Registration Examination (NZREX) exam). 7 Australian Medical Council. (2012). "Competent authority pathway." Retrieved 24/07/2013, from 8 Ibid. 9 DoctorConnect. (2013). "Skills recognition." Retrieved 24/07/2013, from 10 Australian Medical Council. (2012). "Competent authority pathway." Retrieved 24/07/2013, from International Medical Graduate Registration Pathways Page 4

8 Figure 1: Competent Authority Pathway COMPETENT AUTHORITY PATHWAY Eligible IMGs with an AMC approved Primary Medical Degree Assessment for Competent Authority Assessed by AMC, and if successful may apply for Certificate of Advanced Standing Certificate of Advanced Standing Issued by AMC Offer of Employment Pre-Employment Structured Clinical Interview (PESCI) (Not required for all positions) Apply for Limited Registration with MBA Limited Registration Period of Supervised Training A minimum 12 months period of Workplace-Based Performance Assessment AMC Certificate Apply for General Registration with MBA General Registration International Medical Graduate Registration Pathways Page 5

9 4 Standard Pathway The Standard Pathway (Figure 2) is generally for non-specialist IMGs seeking General Registration in Australia, who do not qualify for the Competent Authority Pathway 11. Under this pathway, the AMC conducts two alternative processes leading to the AMC Certificate 12 : Standard Pathway (AMC examinations). Assessment is by examination only - the AMC Computer Adaptive Test (CAT) Multiple Choice Question (MCQ) Examination and the AMC Clinical Examination. Most non-specialist applicants will be assessed through this method. Standard Pathway (workplace-based assessment (WBA)). Assessment is by examination and workplace-based assessment - the AMC CAT MCQ Examination and workplace-based assessment of clinical skills and knowledge by an AMC-accredited authority. AMC accredited authorities for hospital-based WBA programs are in New South Wales, Western Australia, Tasmania, and Victoria). In addition, a pilot program has also been approved for the Australian College of Rural and Remote Medicine (ACRRM) to conduct a WBA program in general practice which may include sites across regional, rural and remote Australia. Workplace-Based Assessment is a pilot program and findings from the program are expected to be available mid IMGs must pass the AMC MCQ Examination, which tests knowledge of the principles and practice of medicine 13, before IMGs can be assessed for the clinical component through either the AMC Clinical Examination 14 or through WBA by an AMC-accredited authority 15. Assessment for Standard Pathway To proceed with the Standard Pathway, IMGs must apply to the AMC under the Standard Pathway and the AMC will assess each IMG s application to determine and confirm eligibility for this pathway 16. If the AMC determines that IMGs are eligible to proceed through the Standard Pathway, IMGs must sit and pass the AMC MCQ Examination. Once an IMG has passed the AMC MCQ Examination, they may apply for jobs if they have not yet secured one. A PESCI may need to be conducted to determine an IMG s suitability for a position, 11 Australian Medical Council. (2012). "Standard pathway." Retrieved 24/07/2013, from 12 Ibid. 13 Australian Medical Council. (2012). "AMC CAT MCQ Examination." Retrieved 24/07/2013, from 14 Australian Medical Council. (2013). "AMC Clinical Examination." Retrieved 24/07/2013, from 15 Australian Medical Council. (2013). "Workplace-based assessment (standard pathway)." Retrieved 24/07/2013, from 16 Australian Medical Council. (2012). "Standard pathway." Retrieved 24/07/2013, from International Medical Graduate Registration Pathways Page 6

10 particularly for general practice and primary health positions 17. If successful, the IMG may then apply for Limited Registration with the MBA. Information about Limited Registration is provided under the Registration section of this document. Under the Standard Pathway, IMGs must then complete the second phase of assessment - either the AMC Clinical Examination or the WBA 18. Upon successful completion of either the AMC Clinical Examination or the WBA and a minimum of 12 months supervised practice (during which IMGs also receive the AMC Certificate), IMGs are then eligible to apply for General Registration with the MBA. Information about General Registration is provided under the Registration section of this document. 17 Medical Board of Australia. (2011). "Obligations on Medical Practitioners." Retrieved 24/07/2013, from 18 Australian Medical Council. (2012). "Standard pathway." Retrieved 24/07/2013, from International Medical Graduate Registration Pathways Page 7

11 Figure 2: Standard Pathway STANDARD PATHWAY Eligible IMGs who do not qualify for the Competent Authority Pathway AMC MCQ Examination Offer of Employment Pre-Employment Structured Clinical Interview (PESCI) (Not required for all positions) Apply for Limited Registration with MBA Limited Registration Clinical Examination Workplace-Based Assessment Period of Supervised Practice A minimum 12 months period of Workplace-Based Performance Assessment AMC Certificate Apply for General Registration with MBA General Registration International Medical Graduate Registration Pathways Page 8

12 5 Specialist Pathway The Specialist Pathway 19 is for IMGs seeking registration as a specialist who have completed specialist training and are recognised as a specialist in their country of training. The IMG s specialist education, training and relevant experience are assessed by the relevant specialist college against the standard required for an Australian-trained specialist in the same field of specialty practice. The AMC conducts the Primary Source Verification, and once this process has been initiated, refers the application on to the relevant specialist college for assessment. The MBA has announced changes to this process with effect from 1 July The AMC will no longer conduct the initial vetting of applications before referring them on to the relevant specialist college for formal assessment. IMG s will apply directly to the College for specialist assessment. Assessment for Specialist Pathway Once it has been determined that the Specialist Pathway is the appropriate pathway for an IMG, they must apply to the AMC for Assessment of Recognition as a Specialist (Figure 3). The AMC conducts an initial assessment of the IMG s application (information and supporting documents) for specialist recognition and, if suitable, the application is referred to the appropriate medical college for further assessment 20. The College assesses an IMG s education, training and experience against the education, training and experience of an Australian-trained specialist 21. Through this process, the college determines the comparability status of IMGs. IMGs are assessed as either comparable or non-comparable. Non-comparable IMGs can apply for either the Competent Authority Pathway or the Standard Pathway, whichever is most appropriate. Comparable IMGs progress through specialist assessment with their respective colleges. Some colleges will offer Fellowship to IMGs who are deemed fully comparable, without the need for any further assessment, although IMGs may still be required to fulfill a period (12 months) of peer review. Not all colleges provide this option; IMGs of colleges where this option is not available will need to fulfill the specialist assessment requirements of their respective colleges. 19 Australian Medical Council. (2012). "Specialist pathway (specialist recognition)." Retrieved 24/07/2013, from 20 Ibid. 21 Australian Medical Council. (2012). "Assessment pathways." Retrieved 24/07/2013, from International Medical Graduate Registration Pathways Page 9

13 Figure 3: IMGs Self-Assessment Specialist Pathway IMGs self-assessment of eligibility for Specialist Pathway AMC Initiates Primary Source Verification Specialist Medical College Assessment Specialist Medical Colleges Specialist Medical Colleges determine the processes and assessment requirements for their respective specialties. The colleges are: Australasian College for Emergency Medicine. Australasian College of Dermatologists. Australasian College of Sports Physicians. Australian and New Zealand College of Anaesthetists. Australian College of Rural and Remote Medicine. College of Intensive Care Medicine of Australia and New Zealand. The Royal Australasian College of Medical Administrators. Royal Australasian College of Surgeons. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. The Royal Australian and New Zealand College of Ophthalmologists. The Royal Australian College of General Practitioners. The Royal Australasian College of Physicians. The Royal Australian and New Zealand College of Psychiatrists. The Royal Australian and New Zealand College of Radiologists. The Royal College of Pathologists of Australasia. The next two chapters outline the registration processes for the two general practitioner colleges, The Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM). For more information about the specialist assessment for other Specialist Medical Colleges please contact the relevant college directly. International Medical Graduate Registration Pathways Page 10

14 6 The Royal Australian College of General Practitioners The Royal Australian College of General Practitioners assesses applications for general practitioner recognition under its Specialist Pathway Program (SPP). The SPP (Figure 4) 22 provides a pathway to Fellowship of The Royal Australian College of General Practitioners (FRACGP) for IMGs, based on an assessment of their previous training and experience in general practice against the qualifications and experience of Australian-trained general practitioners 23. RACGP receives applications via the AMC. Once received, RACGP advises IMGs to apply directly to the College. IMGs are asked to self-categorise themselves to determine if they are eligible for the SPP and which category they may be eligible for 24. Category 1 IMGs with eligible qualifications (see Appendix B - RACGP Recognised Qualifications Category 1) may be categorised as Category 1 IMGs, or as eligible applicants for Fellowship ad eundem gradum A (FAEG) 25. Any of the qualifications listed that were gained through grandfathering B or reciprocal arrangements may not be accepted for FAEG and documentation of training and assessment will be requested 26. IMGs deemed to be comparable for Category 1 are not required to complete any College examinations and are able to apply for FRACGP; they will be awarded FAEG and can apply for Specialist Registration with the MBA 27. Within the first twelve months, these IMGs must enter into a mentoring relationship with a doctor of FRACGP status. To maintain their FAEG, these IMGs are also required to do the following within the first six months of commencing practice in Australia 28 : Participate and comply with the RACGP s Quality Improvement and Continuing Professional Development (QI&CPD) program. A ad eundem gradum: Latin term that refers to the honorary granting of academic standing or a degree by a university to one whose actual work was done elsewhere. B Grandfathering refers to the exemption of someone or something from a new law or regulation. 22 Royal Australian College of General Practitioners. (2010). "Specialist pathway overview flow chart." from 23 Royal Australian College of General Practitioners. (2013). "Specialist pathway program." Retrieved 30/07/2013, from 24 Ibid. 25 Ibid. 26 Ibid. 27 Royal Australian College of General Practitioners (2010). Categorisation. RACGP Specialist Pathway Program Policies and Standards. Melbourne, RACGP. 28 Ibid. International Medical Graduate Registration Pathways Page 11

15 Complete gplearning online Modules 1 and 2 ( GP pathways ) and Module 3 ( Contextual Skills ). Successfully complete Basic Cardiopulmonary Resuscitation training in Australia. Become registered with the MBA and enrol on Medicare s Fellowship register. Category 2 IMGs with eligible qualifications (see Appendix B - RACGP Recognised Qualifications Category 2) may be categorised as a Category IMGs deemed partially comparable under Category 2 by the College will be required to undertake a Fitness for Intended Clinical Practice Interview (FICPI); the FICPI assesses an IMG s fitness for a specific practice and also acts as a method for gathering information regarding fitness for general practice 30. IMGs deemed by the RACGP following the FICPI to be suitable for Category 2 are able to apply for Limited Registration with the MBA and are then permitted to practise in supervised general practice, once registered 31. To remain eligible for the SPP, an IMG must within 12 months of the date of registration 32 : Commence supervised general practice with an allocated supervisor. Practise in a general practice suited to the IMG s capabilities (as assessed at the FICPI). Have completed Basic Cardiopulmonary Resuscitation training in Australia. Enrol in the Applied Knowledge Test (AKT). Complete the gplearning online Modules 1 and 2 ( GP pathways ) and Module 3 ( Contextual Skills ) (to be completed within 6 months of being registered). IMGs are also expected to have completed the AKT, the Key Feature Problems (KFP) exam, and the Objective Structured Clinical Examination (OSCE) within two years of obtaining Limited Registration 33. In addition to the above requirements for Category 2, IMGs must also satisfy the following to be eligible for admission to Fellowship 34 : Satisfactory reports from the supervisors and/or medical educators which will include gathered data on Doctors Interpersonal Skills Questionnaire (DISQ) outcomes, learning plan completion, and any other requirements as deemed necessary. Evidence of QI&CPD activity. 29 Royal Australian College of General Practitioners. (2013). "Specialist pathway program." Retrieved 30/07/2013, from 30 Royal Australian College of General Practitioners (2010). Fitness for intended clinical pracitice interivew. Specialist Pathway Program Policies and Standards. Melbourne, RACGP. 31 Royal Australian College of General Practitioners (2010). Categorisation. RACGP Specialist Pathway Program Policies and Standards. Melbourne, RACGP. 32 Ibid. 33 Ibid. 34 Ibid. International Medical Graduate Registration Pathways Page 12

16 Six months full time equivalent practice completed in an Australian general practice (as per RACGP definition). Meet any other requirements for Fellowship that may generally apply according to RACGP policies and regulations at the time. Once an IMG has completed all components of Fellowship for Category 2, an application for Fellowship will be forwarded to the IMG to submit to the RACGP. The achievement of Fellowship is required in order for the IMG to be eligible for Specialty Medical Registration 35. Category 3 IMGs, who self-categorise as being Category 3, should ensure that they meet the requirement of at least four years full time equivalent general practice experience, and must complete at least one year of general practice experience in Australia 36. All Category 3 IMGs are required to enrol in and pass the AKT in order to proceed into the Specialist Pathway Program 37,38. Once the applicant has achieved a pass in the AKT the IMG is directed to apply to the AMC for verification of their qualification. The application is then referred to the RACGP for formal categorisation and assessment. IMGs deemed by the College to be partially comparable under Category 3 will be required to undertake a FICPI. IMG s who are deemed by the RACGP to be suitable for Category 3, are able to apply for Limited Registration with the MBA and are then permitted to practise in supervised general practice, once registered 39. As with Category 2, Category 3 IMGs must fulfil the following to be eligible for admission to Fellowship via the Specialist Pathway Program 40 : Requirements for entry into Category 3 of the Specialist Pathway met. Supervised general practice with an allocated supervisor commenced. Current Australian medical registration held. gplearning online Modules 1, 2 ( GP pathways ) and Contextual Skills module 3 completed. Satisfactory reports from the supervisors and/or medical educators which will include gathered data on DISQ outcomes, learning plan completion, and any other requirements as deemed necessary. Evidence of QI&CPD engagement. Completed Basic Cardiopulmonary Resuscitation training in Australia. 35 Ibid. 36 Royal Australian College of General Practitioners. (2013). "Specialist pathway program." Retrieved 30/07/2013, from 37 Ibid. 38 Royal Australian College of General Practitioners (2010). Categorisation. RACGP Specialist Pathway Program Policies and Standards. Melbourne, RACGP. 39 Ibid. 40 Ibid. International Medical Graduate Registration Pathways Page 13

17 Passed the remaining two exam segments within 24 months of gaining provisional registration in the Specialist Pathway Program and/or within 36 months of passing the AKT: o KFP o OSCE. 12 months fulltime equivalent Australian general practice experience. Any other requirements for Fellowship that may generally apply according to RACGP policies and regulations at the time. IMGs considered not comparable under the RACGP SPP are advised to seek an alternative course to registration 41. The RACGP Specialist Pathway is detailed below (Figure 4) Royal Australian College of General Practitioners. (2013). "Specialist pathway program." Retrieved 30/07/2013, from 42 Royal Australian College of General Practitioners. (2010). "Specialist pathway overview flow chart." from International Medical Graduate Registration Pathways Page 14

18 Figure 4: RACGP Specialist Pathway Royal Australian College of General Practitioners Specialist pathway overview flow chart. International Medical Graduate Registration Pathways Page 15

19 7 Australian College of Rural and Remote Medicine The Australian College of Rural and Remote Medicine assesses applications for general practitioner recognition, but only from countries where qualifications are considered by the College to be comparable to Australian standards (see Appendix C ACRRM Codified List of Suitable Qualifications) 43. ACRRM receives applications via the AMC then advises IMGs to apply directly to the College. ACRRM conducts an initial assessment of an IMG s application and, if successful, the IMG progresses to an interview 44. The interview further determines the comparability level of an IMG to an Australian-trained fellow 45. IMGs are assessed as either substantially comparable or partially comparable. The interview is also an opportunity for the College to identify any training or professional development needs. IMGs that are deemed substantially comparable are required to complete a period of supervised general practice which is peer reviewed, enrol in a professional development program and orientation for IMGs 46, and complete a Multiple Source Feedback (MSF) assessment 47. IMGs deemed partially comparable follow the same process as substantially comparable IMGs, but may need to undertake additional assessment exercises such as the ACRRM MCQ Exam, the mini- Clinical Evaluation Exercise (mini-cex), and the Structured Assessment using Multiple Patient Scenarios (StAMPS) examination 48. IMGs are granted Fellowship if they have successfully fulfilled all components of the required pathway. Once granted Fellowship, IMGs can apply to the MBA for Specialist Registration. The ACRRM pathway to specialisation is detailed below (Figure 5) Australian College of Rural and Remote Medicine. (2013). "Codified list of suitable qualifications." Retrieved 30/07/2013, from pdf. 44 Australian College of Rural and Remote Medicine. (2013). "Specialist pathway for General Practice." Retrieved 30/07/2013, from 45 Ibid. 46 Australian College of Rural and Remote Medicine. (2011). "ACRRM specialist pathway process flow chart." Retrieved 30/07/2013, from 47 Australian College of Rural and Remote Medicine (2013). Handbook for fellowship assessment,. Brisbane. 48 Ibid. 49 Australian College of Rural and Remote Medicine. (2011). "ACRRM specialist pathway process flow chart." Retrieved 30/07/2013, from International Medical Graduate Registration Pathways Page 16

20 Figure 5: ACRRM Specialist Pathway Australian College of Rural and Remote Medicine ACRRM specialist pathway process flow chart. International Medical Graduate Registration Pathways Page 17

21 8 Assessment Processes for Registration IMGs in each pathway are assessed to determine whether they should be awarded the AMC certificate or specialist recognition/fellowship. In addition, specialist medical colleges have their own assessment processes to determine comparability of IMGs for the Specialist Pathway. During the registration process all IMGs are required to provide the following: Proof of identity. Evidence of application for primary source verification of medical qualifications. Evidence of successful completion of a period of internship or comparable. Evidence of English language skills. Evidence of work practice history that meets the Board s recency of practice registration standard. Details of registration history including certificates of good standing/registration status from each registration authority with which the applicant has previously been registered in the previous ten years. Sponsoring employer s written confirmation of offer of employment. Written confirmation from the proposed supervisor that they agree to provide supervision and to comply with supervision obligations as required by the Board. Satisfactory completion of a criminal history check undertaken by the Board. Evidence of complying with the Board s professional indemnity insurance registration standard. English Language Proficiency Under the National Law, the MBA requires IMGs to provide proof of English language proficiency 50,51 for all registration categories. IMGs must provide evidence of English language proficiency; the following levels are acceptable: Occupational English Test (OET), with grades A or B. International English Language Testing System (IELTS), with scores of 7 or higher in each of the 4 components. Professional Linguistic Assessment Board (PLAB) in the United Kingdom; a PLAB pass letter. New Zealand Registration Examination (NZREX) in New Zealand; a pass. The results of the English language examinations must be obtained in one sitting and are valid for only two years from the date of issue. 50 Medical Board of Australia. (2011). "Obligations on Medical Practitioners." Retrieved 24/07/2013, from 51 Medical Board of Australia (2010). English language skills registration standard. Melbourne, Australian Health Practitioner Regulation Agency. International Medical Graduate Registration Pathways Page 18

22 IMGs with an English language background may not be required to undertake an English language proficiency test, but must provide adequate evidence that their secondary education and/or primary medical qualification was conferred in one of the following countries: Australia Canada New Zealand Republic of Ireland South Africa United Kingdom United States of America. Verification of Qualifications The AMC conducts Primary Source Verification for IMGs and requires IMGs to have their qualifications verified 52 through the Educational Commission for Foreign Medical Graduates International Credentials Services. The EICS verification is mandatory under the National Law for all IMGs seeking registration in Australia and is conducted by the AMC. Competent Authority Pathway and/or Standard Pathway Assessment Processes AMC Certificate of Advanced Standing The AMC Certificate of Advanced Standing is issued by the AMC to IMGs who have demonstrated that they meet the eligibility criteria for the Competent Authority Pathway 53. The AMC Certificate of Advanced Standing enables IMGs to apply to the MBA for Limited Registration. The issuing of the AMC Certificate of Advanced Standing will no longer be relevant after 30 June 2014 following changes to the Competent Authority Pathway which come into effect from 1 July AMC Certificate The AMC Certificate is issued in both the Competent Authority Pathway or Standard Pathway by the AMC to IMGs that have successfully completed twelve months of supervised practice 54,55. The AMC Certificate allows IMGs to apply for General Registration with the MBA. 52 Australian Medical Council. (2012). "Primary source verification." Retrieved 24/07/2013, from 53 Australian Medical Council. (2012). "Competent authority pathway." Retrieved 24/07/2013, from 54 Ibid. 55 Australian Medical Council. (2012). "Standard pathway." Retrieved 24/07/2013, from International Medical Graduate Registration Pathways Page 19

23 AMC CAT Multiple Choice Questionnaire Examination The AMC CAT Multiple Choice Questionnaire (MCQ) Examination 56 assesses an IMG s knowledge of the principles and practice of medicine in the fields of general practice, internal medicine, paediatrics, psychiatry, surgery, and obstetrics and gynaecology. It focuses on essential medical knowledge involving understanding of the disease process, clinical examination and diagnosis, and investigation, therapy and management. IMGs who have passed the AMC CAT MCQ Examination are eligible to find and apply for a relevant job vacancy, once a job has been secured IMGs can apply for Limited Registration with the MBA. As Limited Registration is location-specific, Limited Registration cannot be provided until applicants have secured a position. Once an IMG has passed the AMC CAT MCQ Examination, they can apply to sit the AMC Clinical Examination or, subject to obtaining a suitable position with an accredited employer, undertake Workplace-Based Assessment (see below for more information). AMC Clinical Examination The AMC Clinical Examination 57 assesses an IMG s clinical skills in medicine, surgery, obstetrics, gynaecology, paediatrics and psychiatry. It also assesses the ability of an IMG to communicate with patients, the families of patients, and other health professionals. Workplace-Based Assessment The Workplace-Based Assessment 58 (WBA) is an alternative to the AMC Clinical Examination and is available to eligible IMGs in the Standard Pathway. WBA provides the opportunity for IMGs to have their clinical skills and knowledge assessed on ongoing basis during their everyday clinical practice. WBA also assesses how well IMGs interact with patients and other health professionals. 56 Australian Medical Council. (2012). "AMC CAT MCQ Examination." Retrieved 24/07/2013, from 57 Australian Medical Council. (2013). "AMC Clinical Examination." Retrieved 24/07/2013, from 58 Australian Medical Council. (2013). "Workplace-based assessment (standard pathway)." Retrieved 24/07/2013, from International Medical Graduate Registration Pathways Page 20

24 Pre-Employment Structured Clinical Interview The Pre-Employment Structured Clinical Interview 59 (PESCI) is an assessment of an IMG s clinical experience, knowledge, skills and attributes against the position, and is administered by an MBA authorised body. The assessment process consists of a structured interview, referee checks and a fee payable by the IMG. The PESCI assesses IMGs : Medical Interviewing skills. Physical Examination skills. Clinical Judgment. Treatment / Advice. Communication skills. Professionalism. Procedural skills. Only some IMGs in general practice or primary health positions maybe required to undertake a PESCI. In order for the PESCI to be conducted, an authorised provider requires the IMG to provide copies of the position description of the position the IMG will be filling or applying for, the practice/hospital profile, as the IMG s qualifications, skills and experience will be assessed against these to determine the IMG s suitability for the position. Period of Supervised Practice A period of supervised practice can refer to either the supervised practice required for IMGs to receive an AMC Certificate or any period of supervised practice as defined by the MBA when granting registration to individual medical practitioners. Specialist Pathway Assessment Processes Royal Australian College of General Practitioners Quality Improvement and Continuing Professional Development The Quality Improvement and Continuing Professional Development (QI&CPD) program supports the development and maintenance of GP skills and lifelong learning 60. The program underpins the delivery of high quality medical services to the Australian community. 59 DoctorConnect. (2013). "Skills recognition." Retrieved 24/07/2013, from 60 Royal Australian College of General Practitioners. (2011). "About the program." Retrieved 25/07/2013, from International Medical Graduate Registration Pathways Page 21

25 Fitness for Intended Clinical Practice Interview The Fitness for Intended Clinical Practice Interview (FICPI) assesses an IMG s suitability for employment in a specific general practice position 61. gplearning The gplearning is the College's online interactive continuing professional development learning tool, which has over 100 activities that are valuable for refreshing clinical knowledge 62. Applied Knowledge Test The Applied Knowledge Test (AKT) is the first component of the Fellowship Exam, involving a three hour multiple choice test (which candidates are given four hours to complete). It assesses the breadth and application of contextual knowledge required for certification to enter unsupervised general practice 63. Key Feature Problems The Key Feature Problems (KFP) test is the second component of the Fellowship Exam. It is a threehour multiple choice and short answer test (that candidates are given three and haft hours to complete), which assesses clinical decision-making skills in general practice cases 64. Objective Structured Clinical Exam The Objective Structured Clinical Exam (OSCE) is the third component of the Fellowship Exam, involving a series of fourteen clinical cases. It is conducted with examiners and role players, and assesses applied knowledge, clinical reasoning, clinical skills, communication skills and professional attitudes in the context of consultations, patient exams and peer discussions 65. Australian College of Rural and Remote Medicine Multiple Choice Question Exam The Multiple Choice Question (MCQ) Exam provides an assessment of the doctor s recall, reasoning and applied clinical knowledge 66. The exam is designed to address specific components of the curriculum and focuses on topics and concepts that are important to the everyday experience of rural and remote doctors in practice Royal Australian College of General Practitioners (2010). Fitness for intended clinical pracitice interivew. Specialist Pathway Program Policies and Standards. Melbourne, RACGP. 62 Royal Australian College of General Practitioners. (2013). "pglearning (online learning)." Retrieved 25/07/2013, from 63 Royal Australian College of General Practitioners (2013). Exam handbook for candidates. Melbourne, RACGP. 64 Ibid. 65 Ibid. 66 Australian College of Rural and Remote Medicine (2013). Handbook for fellowship assessment,. Brisbane. 67 Ibid. International Medical Graduate Registration Pathways Page 22

26 Mini Clinical Evaluation Exercise The Mini-Clinical Evaluation Exercise (mini-cex) provides the opportunity to observe and assess the clinical skills of doctors 68. The mini-cex assesses six areas of competency including history taking and physical examination. Structured Assessment using Multiple Patient Scenarios The Structured Assessment using Multiple Patient Scenarios (StAMPS) tests the higher order functions in a highly contextualised framework, where doctors have the opportunity to explain what they are doing and demonstrate their clinical reasoning 69. Multiple Source Feedback The Multiple Source Feedback (MSF) assesses a doctor s interpersonal and professional behaviour, development and clinical skills 70. The MSF consists of two components, the first is a colleague assessment tool and a self-assessment tool, and the second is a patient assessment tool. 68 Ibid. 69 Ibid. 70 Ibid. International Medical Graduate Registration Pathways Page 23

27 9 Registration Under the National Law, the MBA has three categories of registration available to IMGs, under which they can practise medicine in Australia. The three types of registration are Limited, Provisional, General, and Specialist. Limited Registration There are four types of Limited Registration, granted for different purposes. These allow IMGs to provide medical services under supervision. Limited Registration is available to both specialist IMGs and non-specialist IMGs, is granted for up to twelve months, and can be renewed after this period, up to a maximum of three renewals 71. The MBA cannot renew Limited Registration more than three times; however, a new application for Limited Registration can be made. Limited Registration is dependent on the type of practice, and is limited by scope, duration and location. The two most commonly used types of Limited Registration for IMGs are Limited Registration Area of Need and Limited Registration Postgraduate Training or Supervised Practice. There are two other types of Limited Registration available to IMGs, which provide registration for short periods of time and with limited scope of practice. The first is Limited Registration Public Interest, and the second is Limited Registration Teaching or Research. IMGs applying for Limited Registration with the MBA will be required to provide the following: Proof of identity. Evidence of application for primary source verification of medical qualifications. Evidence of successful completion of a period of internship or comparable. Evidence of English language skills. Evidence of work practice history that meets the Board s recency of practice registration standard. Details of registration history including certificates of good standing/registration status from each registration authority with which the applicant has previously been registered in the previous ten years. Sponsoring employer s written confirmation of offer of employment. Written confirmation from the proposed supervisor that they agree to provide supervision and to comply with supervision obligations as required by the Board. Satisfactory completion of a criminal history check undertaken by the Board. 71 Medical Board of Australia. (2013). "Limited Registration." Retrieved 24/07/2013, from International Medical Graduate Registration Pathways Page 24

28 Limited Registration Area of Need Medical practitioners with Limited Registration Area of Need 72 are working under supervision in an area of medical workforce shortage. Often, they are registered to practise in a rural or remote location. These practitioners have been assessed by the MBA as having the necessary skills, training and experience to undertake this practice safely. The state or territory Minister for Health (or their delegate) must declare that the area in which the applicant will work is an area of need. Medical practitioners with this type of registration must comply with the MBA registration standard on Limited Registration Area of Need; this includes: Compliance with a supervision plan. Compliance with a professional development plan. Authorising and facilitating the provision of regular reports from their supervisors to the MBA about their safety and competence to practise. Satisfactory performance in the area of need. If intending to practise medicine in Australia long term, providing evidence to confirm satisfactory progress towards meeting the qualifications required for General Registration or Specialist Registration. Limited Registration for Postgraduate Training or Supervised Practice Limited Registration for Postgraduate Training or Supervised Practice 73 can be granted to IMGs who are undertaking supervised training in Australian hospitals or other health care facilities. IMGs may intend to return to their country of training after completing their training in Australia, or have their specialist qualifications assessed by an Australian specialist college. This is also a suitable type of registration for medical practitioners who are undertaking training so that they can sit the AMC Examination. Medical practitioners with this type of registration must comply with the MBA s registration standard on Limited Registration Postgraduate Training or Supervised Practice; this includes: Compliance with a supervision plan. Compliance with a professional development plan. Authorising and facilitating the provision of regular reports from their supervisors to the MBA about their training plan. Satisfactory performance in the postgraduate training or supervised practice position. 72 Medical Board of Australia. (2013). "Area of need." 24/07/2013, from 73 Medical Board of Australia. (2013). "Postgraduate training or supervised practice." Retrieved 24/07/2013, from International Medical Graduate Registration Pathways Page 25

29 If intending to practise medicine in Australia long term, providing evidence to confirm satisfactory progress towards meeting the qualifications required for General Registration or Specialist Registration. Generally, IMGs working in a general practice position apply for Limited Registration Area of Need or, if working in a hospital-based position, either Limited Registration Area of Need or Limited Registration Postgraduate Training or Supervised Practice. Limited Registration Public Interest Limited Registration Public Interest 74 is intended to be short-term, with a limited scope of practice. It applies to circumstances in which the MBA deems there is a public interest in registering a medical practitioner. For example, during the event of a natural disaster. All medical practitioners with Limited Registration Public Interest are required to have supervision. They are also required to: Perform satisfactorily in the position. Authorise and facilitate the provision of regular reports from their supervisors to the MBA about their safety and competence to practice. IMGs with this form of registration who are granted more than four weeks registration must also comply with a professional development plan. This is not a suitable type of registration for medical practitioners who are working towards General or Specialist Registration. It is not an alternative to Limited Registration Area of Need. Limited Registration Teaching or Research IMGs with Limited Registration Teaching or Research 75 will be working in a position that involves clinical teaching or research. These IMGs can undertake limited clinical practice that is relevant to their teaching or research role. IMGs with Limited Registration Teaching or Research are required to: Comply with a supervision plan if they are undertaking any clinical practice. Comply with a professional development plan. Authorise and facilitate the provision of regular reports from their supervisors to the MBA about their safety and competence to practice. 74 Medical Board of Australia. (2013). "Public interest." Retrieved 24/07/2013, from 75 Medical Board of Australia. (2013). "Teaching or research " Retrieved 24/07/2013, from International Medical Graduate Registration Pathways Page 26

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