Medical Training Review Panel: sixteenth report
Medical graduates of Australian universities enter the medical workforce as interns, also known as postgraduate year 1 (PGY1) doctors, employed predominately through public health services. Satisfactory completion of the intern year is required before these junior doctors are granted general medical registration. Prior to July 2010, registration was through the relevant state or territory medical board. After introduction of the National Registration and Accreditation Scheme on 1 July 2010, junior doctors, and all medical practitioners, are registered through a single national board, the Medical Board of Australia (MBA).
Interns undertake a series of rotations to enable them to experience a range of clinical situations and service environments and to satisfy MBA registration requirements. These rotations must be accredited in accordance with guidelines developed by the state and territory Postgraduate Medical Councils or Institutes of Medical Education and Training. Placements must ensure adequate case-mix, service, teaching, supervision and assessment.
Prior to commencing a vocational training program, most junior doctors work for at least one, two or more years after their intern year, in the public hospital system and community health services, to gain more clinical experience with greater levels of responsibility. A key aim of this experience is to consolidate the clinical skills developed during university training and the intern year, and to equip junior doctors with the prerequisite experience and procedural skills for entry into specialist or vocational training programs.
Training at the prevocational level generally involves rotating between clinical departments in regional and urban public hospitals with some rotation from urban hospitals to regional and rural hospitals and community settings, including general practice. Such rotations are intended to give junior doctors experience of broader range of clinical settings, as well as meet service delivery needs.
While a number of specialist medical colleges may accept entrants to vocational training programs directly following completion of PGY1, most prefer applicants to have completed a second or even third year of prevocational training (PGY2 and PGY3). Doctors in this period of prevocational on-the-job training are usually referred to as a ‘Resident Medical Officer’ (RMO). The term ‘Hospital Medical Officer’ (HMO) is used in Victoria and the term ‘Trainee Medical Officer’ (TMO) in South Australia.
Not all PGY2 and PGY3 doctors will enter vocational specialist training. Some are waiting for a place in their selected vocational training specialty, but others will leave the medical workforce, pursue a research career, choose to work as locums or continue to work in hospital settings in non-vocational career role, typically as Career Medical Officers (CMOs). Most CMOs work in hospital settings, a number of CMOs acquire other postgraduate qualifications related to their roles, such as early management of severe trauma, advanced paediatric support or emergency life support.
Caution is needed in interpreting and analysing some of the prevocational data. The numbers presented are sometimes estimates, with administration systems often not capturing data in a way that matches the breakdown of information for MTRP reporting purposes and the number of trainees, particularly in PGY2, are an underestimate. Also, some state and territories have different prevocational training processes. For instance, in New South Wales, trainees are employed on two year contracts covering both PGY1 and PGY2 training. This means that the number of PGY2 positions advertised each year and offered does not reflect the total number of PGY2 positions available.
Attempts to capture all training and supervisory activities have continued this year through broadening the specifications, to include supervision and additional training of overseas trained doctors as necessary for recognition of their qualifications with Australia. The degree to which state and territory administration systems have been able to accurately capture this information is unknown.