Medical Training Review Panel: thirteenth report
Vocational Medical Training
This chapter reports on vocational training recognised under the Health Insurance Act 1973. It presents data on the number of vocational medical training places in 2009, the results of college examinations held in 2008, the number of new college fellows in 2008 and the number of first year placements likely to be available in 2010 for each of the specialty areas. All data were current as at July 2009.
The following data has been provided by all of the specialist medical colleges and associated faculties, and General Practice Education and Training (GPET).
Data for the latest five years is presented where applicable. Tables containing data from earlier years of reporting are located in Appendix D.
Vocational Medical Training in AustraliaFollowing completion of university medical education and the pre-requisite intern year, medical graduates may decide to undertake specialist medical practice. In order to do this, they must complete a recognised medical specialty training program.
The only accredited providers of such programs are the specialist medical colleges. These are accredited by the Australian Medical Council (AMC). The AMC was established by Australian Health Ministers in 1984, as the independent national standards body for medical education and training. The AMC advises the Commonwealth and states and territories on the recognition of medical specialties, and reviews and accredits specialist medical education and training programs.
There is no single entry point to vocational training. Specialty training programs start in either the second or third postgraduate year, but not all who enter vocational training do so at the earliest opportunity.
To gain entry into a training program in their chosen specialty, individuals must succeed in a competitive selection process for a fixed number of accredited training positions (posts), or a place in an accredited facility or in an accredited training program. The number of trainee positions offered is also dependent on the health services capacity to accept trainees. Some specialist medical colleges' vocational training programs have a basic and an advanced training component. Basic training is the entry point for specialist training and must be completed before progressing to advanced training. Advanced specialist trainees then work in a series of training positions in which they are supervised and mentored by appropriately qualified specialists. The combination of these training positions constitutes the individual’s advanced training program.
Supervision of junior registrars is usually undertaken by a specialist and/or a senior registrar in association with a specialist. Over time, the registrar takes increasing responsibility for decision making about patient management and learns a wider range of practical skills.
Specialist vocational training has traditionally been undertaken in teaching hospitals for most specialties, but there is now pressure to move some specialty training to an expanded range of settings to better reflect where healthcare is delivered and better satisfy curriculum objectives.
The time required to complete vocational training programs varies from about three to seven years, depending upon which specialty is undertaken.
Most specialist colleges have both clinical and practical exams and the majority have an exit exam. Increasingly, a range of other in-training assessments of both a formative and summative nature are being included so that the full range of skills and behaviours, including communication, team work and other forms of professional behaviour, can be assessed.
General Practice TrainingThe Australian General Practice Training Program (AGPTP) is a postgraduate vocational training program for doctors wishing to pursue a career in general practice in Australia. The AGPTP provides training towards fellowship of the Royal Australian College of General Practitioners (RACGP) and/or fellowship of the Australian College of Rural and Remote Medicine (ACRRM). Training is delivered through 20 regional training providers (RTPs).
The AGPTP is managed by General Practice Education and Training (GPET) Ltd to the standards set by the RACGP and the ACRRM. The RACGP and the ACRRM are, in turn, accredited by the AMC.
The Rural Vocational Training Scheme (RVTS) provides an alternative route to vocational recognition for medical practitioners working in remote areas who find that leaving their practice to undertake the AGPTP is not viable. RVTS registrars are eligible to sit for fellowship of the RACGP and ACRRM. More details about this program are included in Chapter 6.
Registrars can choose between the rural pathway and the general pathway of the AGPTP. The general practice training programs generally take three years to complete if undertaken through the RACGP2 and four years if undertaken via the ACRRM, but may take longer under some circumstances. Training is primarily completed through general practice clinics and is funded by the Australian Government.
Rural pathway registrars undertake their training in rural and remote areas, defined as Areas 3-7 in the Rural, Remote and Metropolitan Areas classification. Metropolitan-based general pathway trainees are also required to undertake at least one placement in a rural and/or an outer metropolitan area.
Changes to College Training ProgramsThe Royal Australasian College of Surgeons (RACS) recently introduced a revised training program. The Surgical Education and Training (SET) program commenced in 2008 and replaced the Basic and Advanced Surgical Training programs. The Surgical Education and Training (SET) program is designed to improve the quality and efficiency of surgical education and training through early selection into specialty training and streamlining of the training experience. The SET program requires five to six years of specialist surgical training in one of nine specialty training areas.
Both specialties of the Royal Australian and New Zealand College of Radiologists (RANZCR) have also been undergoing a curriculum development process.In radiation oncology, the new curriculum commenced in 2009. It is expected that the new curriculum will commence in radiology in 2010.
The Royal Australasian College of Physicians (RACP) has developed a new training program, ‘Physician Readiness for Expert Practice’ (PREP). This has been progressively phased in through 2008 and 2009. This program utilises new formative assessments, greater supervision and a comprehensive e-learning environment.
2 One extra year is required for doctors taking the Fellowship in Advanced Rural General Practice through the RACGP.