Medical Training Review Panel: sixteenth report
Following completion of university medical education and the pre-requisite intern year, the majority of medical graduates decide to undertake specialist medical practice. In order to do this, they must complete a recognised medical specialty training program.
Training is provided through the specialist medical colleges, and in the case of general practice, through General Practice Education and Training Limited (GPET). The training programs 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 an accredited training program. The number of trainee positions offered is also dependent on the health services’ capacity to accept trainees.
The states and territories have different arrangements for managing vocational training. They work with the medical colleges to address particular challenges, such as improving trainee supervision in public hospitals, developing statewide training programs and addressing need for generalists or sub/super specialists. They also offer the training posts to be accredited.
Some specialist medical colleges differentiate their vocational training programs into basic and advanced components. Where required, 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 individuals 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 was traditionally undertaken in teaching hospitals for most specialties; however, it is now undertaken across all public hospitals. As the capacity of these hospitals decreases with the continued high numbers of medical students, as well as students in other health professions, there is added pressure to broaden the range of settings in which specialist training is undertaken. Placements in general practice settings are now routine and there are moves to expand training settings outside of public hospitals in a number of other specialties. These moves are not only due to capacity issues, but also in recognition of the need to better reflect where healthcare is delivered.
Most specialist colleges have both clinical and practical exams and the majority have an exit exam. A range of other in-training assessments of both a formative and summative nature are also conducted by some colleges, so that the full range of skills and behaviours, including communication, team work and other forms of professional behavior, can be assessed.
The time required to complete vocational training programs varies between three to seven full time years, depending upon the specialty. Further information on the specific requirements for each specialty is outline in Appendix B.
General Practice Training
The Australian General Practice Training (AGPT) Program is a postgraduate vocational training program for doctors wishing to pursue a career in general practice. The AGPT Program 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) and id delivered through 17 Regional Training Providers (RTPs) across Australia. The AGPT Program is managed by an Australian Government – owned and funded organisation, General Practice Education and Training Limited, to the standards set by the RACGP and the ACRRM. The RACGP and the ACRRM are, in turn, accredited by the AMC. This model is different to all other vocational training in Australia, where the medical specialist college is both the training delivery and standard-setting organisation.
Registrars can choose between the rural pathway and the general pathway of the AGPT Program. The general practice training programs usually take three years to complete, if undertaken through the RACGP, and four years, if undertaken through the ACRRM, but may take longer under some circumstances. An additional year is required for doctors taking the Fellowship in Advanced Rural General Practice (FARGP) through the RACGP. Training is primarily completed through a combination of hospital terms and general practice clinics although differences exist between the RACGP and ACRRM endpoints. The AGPT program. The AGPT program is funded through the Australian Government.
Rural pathway registrars undertake their training in rural and remote areas, as defined by the Australian Standard Geographical Classification – Remoteness Area (ASGC-RA) as Remoteness Areas 2 to 5. Metropolitan-based general pathway trainees are also required to undertake at least one placement in a rural and/or outer metropolitan area.
The Remote 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 AGPT Program 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.
The ACRRM offers the Independent Pathway as a third route to achieve fellowship of the college (FACRRM). The Independent Pathway is most suited to experienced doctors. It is a self funded pathway.
Changes to College Training in Australia
The Royal Australasian College of Surgeons (RACS) introduced a revised training program, the Surgical Education and Training (SET) program in 2008. This replaced the Basic and Advanced Surgical Training programs and does not distinguish between basic and advanced training components. The 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 program requires five to six years of specialist surgical training in one of nine specialty training areas.
The Royal Australasian College of Physicians (RACP) developed a new training program, ‘Physician Readiness for Expert Practice’ (PREP), which was progressively phased in 2008 in Basic Physician Training and 2011 in Advanced Physician Training. This program utilises new formative assessments, greater supervision and a comprehensive e-learning environment.
Both specialties of the Royal Australian and New Zealand College of Radiologists (RANZCR) underwent a curriculum development process, where the new curriculums commenced for radiation oncology in 2009 and for radiology in 2010.
A comprehensive review of the Australian and New Zealand College of Anaesthetists (ANZCA) curriculum resulted in the redesign of the curriculum and revision of the training program. The new training program comes into effect at the start of the 2013 hospital employment year in Australia and New Zealand.
Australasian Faculty of Occupational and Environmental Medicine (AFOEM) training is based around 3 stages - Stage A is a new ‘basic' stage (from 2011); Stages B and C are advanced training stages.
Further information on the individual training programs for each speciality is outlined in Appendix B.