Medical Training Review Panel: fifteenth report

Requirements for Practising Medicine in Australia

Page last updated: 15 March 2012

Although national examinations for non-specialist IMGs have existed in Australia since 1978, states and territories had adopted different approaches to the assessment of some categories of Area of Need practitioners and specialists. In July 2006 the Council of Australian Governments (COAG) agreed to the introduction of a nationally consistent assessment process for IMGs and overseas trained specialists. COAG gave Health Ministers the responsibility for implementation of this decision and a model for a national process was developed and submitted to Health Ministers on 12 December 2006. The final report on the agreed pathways was presented to the Australian Health Ministers’ Advisory Committee in October 2008.

This model outlines three main assessment pathways:

  • Competent Authority (CA) Pathway;
  • Standard Pathway (including the current AMC examination and a new workplacebased assessment pathway); and
  • Specialist pathways for all specialties, including general practice:
    • Standard specialist assessment
    • Area of Need assessment
    • Overseas trained specialist in specified training position.

The Competent Authority Pathway was implemented from 1 July 2007 and the first stage of the Standard Pathway (workplace-based assessment) for general practitioners and nonspecialist hospital doctors was implemented the following year, from 1 July 2008.

The Australian Medical Council (AMC) is responsible for processing all initial inquiries regarding assessment of IMGs and overseas trained specialists.

Further details on assessment requirements that are common to each of the pathways and the specific requirements of each are provided below.

Common Assessment Requirements

Each of the pathways includes some (or all) of the following steps:

  • assessment of English language proficiency at a nationally agreed level;
  • primary source verification of qualifications;
  • assessment against a position description with the level of assessment according to level of risk (for Area of Need positions);
  • orientation within three months of starting employment and evidence of satisfactory completion of this submitted to the relevant medical board with the supervisor’s three-month report; and
  • access to continuing professional development.

Competent Authority Pathway

Competent Authorities are designated overseas accredited medical training and licensing examination authorities that have been reviewed and approved against criteria developed by the AMC as competent to undertake a basic assessment of medical knowledge and clinical skills for the purposes of registration in Australia. One of the criteria used to recognise a Competent Authority is the extent to which the clinical context of the country in which it operates is consistent with the Australian context of health care. This is defined in terms of the pattern of disease, level of medical technology, delivery of medical education and professional ethics. The AMC has approved four examination authorities in the United Kingdom (PLAB examination), the United States of America (the USMLE examination), Canada (the MCC Licensing Examination) and New Zealand (the NZREX examination). The AMC has also approved medical school accreditation programs in the United Kingdom and the Republic of Ireland as Competent Authorities.

International medical graduates undergo a pre-employment assessment of suitability for a position if required by the Medical Board of Australia. Where the board determines a pre-employment structured clinical interview (PESCI) is required, it is carried out by an AMC-accredited provider against the position description. This may be carried out if required for more senior hospital-based positions and is included as a matter of course for general practice positions.

Doctors eligible for the Competent Authority Pathway are granted advanced standing toward the AMC Certificate and undergo up to 12 months workplace-based assessment to ensure satisfactory adjustment to the Australian health care system before they are eligible to receive the AMC Certificate and apply for general registration.

Table 5.4 shows that a total of 1,355 applicants were assessed through this pathway in 2010. Of these, 1,200 applicants qualified for Advanced Standing. While these are primarily applicants who applied in 2010, the figures also include a number of 2009 applicants who were required to submit additional documentation to confirm their eligibility.

In 2010 a total of 513 AMC Certificates were granted, making the applicants eligible to apply for general registration (Table 5.4). This is considerably less than the 853 granted in 2009. Two thirds of these granted in 2010 were to IMGs from the United Kingdom and the Republic of Ireland.

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Table 5.4: International medical graduates: Applications assessment through Competent Authority Pathway, 2010(a)

(a) Data covers the period 1 January 2010 to 31 December 2010.
(b) Professional Linguistic Assessments Board Exam.
(c) Medical Council of Canada Exam.
(d) United States Licensing Exam.
(e) New Zealand Registration Exam.
(f) General Medical Council of the United Kingdom Accreditation.
(g) Medical Council of Ireland Accreditation.
(h) Other includes: Antigua And Barbuda, Armenia, Bangladesh, Belarus, Chile, China, Colombia, Czech Republic, Dominica, Dominican Republic, Egypt, Germany, Grenada, Guyana, Hungary, Iran, Iraq, Israel, Jordan, Lebanon, Libya, Myanmar, Nepal, Netherlands Antilles, New Zealand, Nigeria, Oman, Pakistan, Philippines, Poland, Romania, Russia, Saint Lucia, Saudi Arabia, Somalia, Sri Lanka, Syria, Trinidad And Tobago, Turkey, Ukraine, Uzbekistan, Venezuela, Vietnam, Yemen, Zambia, Zimbabwe.

Source: Australian Medical Council administrative data, 2011

Country of training(b)PLAB(c)MCC(d)USMLE(e)NZREX(f)GMCUK (g)MCITotal Advanced standing issuedCertificate issued
Canada
0
28
1
0
0
0
31
23
2
India
51
2
3
4
0
0
66
53
85
Ireland
0
0
1
0
1
183
193
182
65
South Africa
0
5
1
0
0
0
7
8
3
United Kingdom
0
0
0
0
841
2
873
780
277
USA
0
0
27
0
0
0
31
27
5
Other(h)
77
37
7
14
3
0
154
127
76
Total
128
72
40
18
845
185
1,355
1,200
513

Standard Pathway

Doctors who are not eligible for either the Competent Authority or Specialist pathways are assessed through the Standard Pathway. In addition to the common assessment requirements, this consists of two examinations or assessments:

  • AMC Multiple Choice Questionnaire examination (MCQ); and
  • AMC clinical examination.

A pre-employment clinical interview, namely a PESCI, is also required for all IMGs applying for general practice positions and for some IMGs in hospital positions.

Success in the AMC clinical examination leads to the awarding of the AMC Certificate.

In 2010, 1,999 IMGs passed the MCQ (52.2% of attempts) and 1,013 passed the clinical examinations (63.5% of attempts) (Table 5.5).

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Table 5.5: International medical graduates: Applications assessed through Standard Pathway, 2010(a)

(a) Data covers the period 1 January 2010 to 31 December 2010.
(b) Other in MCQ Exam includes: Afghanistan, Argentina, Armenia, Australia, Austria, Azerbaijan, Balearic Islands, Belarus, Belgium, Bolivia, Bosnia-Herzegovina, Brazil, Bulgaria, Cambodia, Canada, Cayman Islands, Croatia, Cuba, Czech Republic, Czechoslovakia, Denmark, Dominica, Ecuador, El Salvador, Estonia, Ethiopia, France, Germany, Ghana, Greece, Guatemala, Guinea, Hong Kong, Hungary, Ireland, Israel, Italy, Japan, Kazakhstan, Kenya, Kyrgyzstan, Latvia, Lebanon, Libya, Lithuania, Macedonia, Malta, Mauritius, Mexico, Netherlands, Oman, Palestinian Authority, Paraguay, Peru, Poland, Saint Kitts And Nevis, Samoa, Serbia, Seychelles, Singapore, Slovak Republic, South Korea, Spain, Sudan, Switzerland, Syria, Taiwan, Tajikistan, Tanzania, Thailand, Trinidad And Tobago, Turkey, Uganda, United Arab Emirates, Uruguay, USSR, Venezuela, Yemen.
(c) Other In Clinical Exam Includes: Afghanistan, Algeria, Argentina, Austria, Bahrain, Belarus, Belgium, Bosnia-Herzegovina, Brazil, Bulgaria, Croatia, Denmark, Dominican Republic, El Salvador, Ethiopia, Germany, Greece, Guatemala, Guyana, Hungary, Ireland, Israel, Italy, Japan, Kazakhstan, Kenya, Latvia, Lebanon, Lithuania, Macedonia, Malta, Mauritius, Netherlands, Niger, Oman, Peru, Poland, Saint Kitts And Nevis, Saint Lucia, Serbia, Singapore, Slovak Republic, South Korea, Sudan, Syria, Taiwan, Thailand, Trinidad And Tobago, Turkey, Uganda, United Arab Emirates, USA, USSR, Uzbekistan, Venezuela.

Source: Australian Medical Council administrative data, 2011

Country of trainingMCQ exam attemptsMCQ exam passesClinical exam attemptsClinical exam passes
Bangladesh
223
112
92
44
China
157
65
82
57
Colombia
24
15
8
6
Egypt
118
59
34
29
Fiji
32
16
19
9
India
678
369
358
232
Indonesia
29
6
8
1
Iran
217
132
108
66
Iraq
85
54
40
21
Jordan
27
19
5
2
Malaysia
63
42
8
7
Myanmar
184
111
72
53
Nepal
50
19
17
8
Nigeria
106
51
20
10
Pakistan
442
226
148
89
Papua New Guinea
14
5
5
0
Philippines
293
95
97
46
Romania
30
15
5
4
Russia
136
51
33
22
Saudi Arabia
18
9
1
0
South Africa
60
42
70
62
Sri Lanka
316
237
147
111
Ukraine
65
22
15
8
Vietnam
15
4
5
1
Zimbabwe
14
14
11
8
Other(b)(c)
435
209
188
117
Total
3,831
1,999
1,596
1,013

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Assessment of Overseas Trained Specialists

Prior to 1990, all overseas trained specialists seeking registration in Australia who did not hold a recognised primary medical qualification were obliged to pass the AMC examination and obtain general registration before they could be registered to practise as a specialist. Also, before 1990 only two states (Queensland and South Australia) had separate specialist registers.

In 1991 the Australian Health Ministers Conference (AHMC), in anticipation of the implementation of the mutual recognition scheme, approved a process for overseas trained specialists to be assessed by the relevant specialist medical college in Australia against the standards for an Australian trained specialist in the same field of specialist practice. If the qualifications and relevant experience of the applicant were assessed as substantially comparable to an Australian trained specialist, he/she could apply for registration limited to the field of specialty.

In consultation with the former state and territory medical boards and colleges, it was subsequently agreed that the specialist assessment process should not be seen as a backdoor to specialist training in Australia. For this reason it was resolved that any overseas trained specialist who required more than two years of further supervised training to meet the required standard for substantial comparability (equivalence to an Australian trained specialist) would be assessed as ‘not comparable’ and would be required to sit the AMC examination and obtain general registration.

A national assessment process for Area of Need specialists was not resolved until 2002, when agreement was reached on a separate pathway for the assessment and registration of overseas trained specialists in Area of Need positions. This involves an assessment against a position description that defines the levels of clinical responsibility, supervision and specific clinical skills required for a particular position. The relevant specialist college assesses the individual against the position description, rather than against the standards required by the medical college for a (fully recognised) specialist.

A number of colleges have agreed to combine their Area of Need and full comparability assessments, so that the applicant (and the Medical Board of Australia) can be advised of the additional steps required to achieve substantial comparability at the same time as he or she is being assessed for the Area of Need position. To date some nine colleges (RANZCOG, RACP, RCPA, ACD, RACS, RANZCO, RANZCP, ACRRM and RANZCR) have agreed to undertake the combined assessments of overseas trained specialists.

All specialist applications are administered through the AMC and assessment of comparability to Australian standards is carried out by the relevant specialist college. Applicants who do not meet the requirements for specialist assessment are required to undergo assessment through one of the non-specialist pathways.

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Standard Specialist Assessment

Overseas trained specialists applying for comparability to an Australian trained specialist must have completed all training requirements and be recognised as a specialist in their country of training before applying under the specialist pathway for assessment of comparability.

There are three possible outcomes of assessment

  • Substantially comparable;
  • Partially comparable, requiring up to two years upskilling to reach comparability; and
  • Not comparable.

The majority of medical colleges will allow applicants who are considered substantially comparable to Australian trained specialists to gain fellowship without requiring an additional examination. International medical graduates with specialist qualifications or specialists-in-training are eligible to apply for general registration under the Competent Authority Pathway (if eligible), in addition to applying for specialist registration through the Specialist Pathway.

In total there were 1,564 overseas trained specialists whose applications to be recognised as a specialist in Australia were being processed in 2010. While these are primarily applicants who applied the previous year, this figure also includes a number of applicants who were required to submit additional documentation or undergo further training to confirm their eligibility.

Table 5.6 shows that 469 overseas trained specialists had their applications approved (that is they were deemed to be substantially comparable) and a further 288 were deemed as requiring further training and/or examinations (that is partially comparable).

Table 5.7 presents data on the countries in which approved applicants were trained. Almost half (210 or 44.8%) of all overseas trained specialists, who have had their applications approved in 2010 were trained in the United Kingdom and Ireland. This is over double the number from these countries approved in 2009 (84 or 25.3%). The next largest number of specialists in 2010 came from India (84 or 17.9% of all approved applicants).

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Table 5.6: Specialist assessment process by medical specialty, 2010

(a) Oral and Maxillofacial surgery is both a dental and medical specialty.

Source: Australian Medical Council administrative data, 2011

Medical specialtyInitial processingCollege processingSubstantially comparablePartially comparableNot
comparable
WithdrawnTotalProportion of total (%)
Adult medicine
93
3
88
21
9
8
222
14.2
Anaesthesia
32
12
38
48
9
9
148
9.5
Dermatology
8
1
3
2
3
0
17
1.1
Emergency medicine
13
5
13
10
0
3
44
2.8
General practice
130
2
71
11
0
9
223
14.3
Intensive care
7
2
2
7
1
4
23
1.5
Medical administration
0
0
0
1
0
0
1
0.1
Obstetrics and Gynaecology
53
0
46
9
13
2
123
7.9
Occupational and Environmental Medicine
1
0
0
0
0
0
1
0.1
Ophthalmology
19
2
5
11
2
1
40
2.6
Oral and maxillofacial surgery(a)
0
2
0
1
0
1
4
0.3
Paediatrics and Child health
44
2
34
15
10
4
109
7.0
Pain medicine
1
0
0
0
0
0
1
0.1
Palliative medicine
0
0
1
1
0
0
2
0.1
Pathology
35
0
19
24
0
4
82
5.2
Psychiatry
41
3
47
40
1
2
134
8.6
Public health medicine
6
0
0
0
0
0
6
0.4
Radiology
22
4
40
43
0
4
113
7.2
Rehabilitation medicine
4
0
1
1
1
1
8
0.5
Sexual health medicine
1
0
0
0
0
0
1
0.1
Surgery
62
21
61
43
25
50
262
16.8
Total
572
59
469
288
74
102
1,564
100.0

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Table 5.7: Substantially comparable specialist applications by country of training and medical specialty, 2010

(a) Other includes: Argentina, Belgium, Brazil, China, Colombia, Croatia, France, Germany, Hong Kong, Iran, Iraq, Israel, Italy, Jordan, Malaysia, Moldova, Nepal, Netherlands, Norway, Pakistan, Papua New Guinea, Philippines, Poland, Romania, Russia, Singapore, Slovak Republic, Spain, Sri Lanka, Sweden, Switzerland, Turkey, Yugoslavia, Zimbabwe.

Source: Australian Medical Council administrative data, 2011

Medical specialtyCanadaIndiaNew ZealandSouth AfricaUnited Kingdom
and Ireland
United States of America(a)OtherTotalProportion of total (%)
Adult medicine
1
24
0
9
38
1
15
88
18.8
Anaesthesia
1
10
0
4
15
0
8
38
8.1
Dermatology
0
1
0
0
2
0
0
3
0.6
Emergency medicine
0
0
0
1
8
3
1
13
2.8
General practice
– RACGP
2
0
15
0
47
0
0
64
13.6
– ACRRM
1
0
0
0
3
3
0
7
1.5
Intensive care
0
0
0
0
1
0
1
2
0.4
Obstetrics and Gynaecology
2
6
0
2
18
2
16
46
9.8
Ophthalmology
0
0
0
1
4
0
0
5
1.1
Paediatrics and Child health
0
3
0
7
18
2
4
34
7.2
Palliative medicine
0
0
0
0
1
0
0
1
0.2
Pathology
0
1
0
3
5
2
8
19
4.1
Psychiatry
0
18
0
4
16
3
6
47
10
Radiology
0
9
0
7
12
2
10
40
8.5
Rehabilitation medicine
0
0
0
0
0
0
1
1
0.2
Surgery
1
12
0
5
22
2
19
61
13.0
Total
8
84
15
43
210
20
89
469
100.0

Area of Need Specialist Assessment

Overseas trained specialists applying for an Area of Need assessment must also have completed all training requirements and be recognised as a specialist in their country of training. When assessing applicants for suitability for Area of Need positions, medical colleges will determine at the same time (or soon thereafter) what is required to meet standards for fellowship.

An Area of Need applicant is always assessed against a position description. The position description together with the qualifications, training and experience of the applicant will determine the level of risk and the level of supervision or further assessment required.

Specified Specialist Training

Applicants who wish to enter Australia for specified specialist training will require registration by the relevant medical board following advice from the relevant specialist medical college. This provisional registration allows applicants to undertake training or to obtain experience in Australia not available in their country of training for a short period (normally up to one year), but can in exceptional circumstances be extended to three years.

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