Medical Training Review Panel: Seventeenth Report

Vocational Medical Training in Australia

Page last updated: 09 April 2014

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 GPET. The training programs are accredited by the Australian Medical Council.

The Australian Medical Council is an independent national standards body for medical education and training. The Australian Medical Council acts as an external accreditation entity for the purposes of the Health Practitioner Regulation National Law. 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 management of vocational training varies across the states and territories. 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 trainees (junior registrars) is usually undertaken by a specialist and/or a senior trainee (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. A number of factors, including capacity constraints in the public hospital system and a recognition that training needs to better reflect where healthcare is delivered, has seen an expansion over the last few years of specialist training positions to private hospitals and community settings.

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 outlined 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 is delivered through 17 Regional Training Providers (RTPs) across Australia. The AGPT Program is managed by the Australian Government – owned and funded organisation, GPET, to the standards set by the RACGP and the ACRRM. The RACGP and the ACRRM are, in turn, accredited by the Australian Medical Council. 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 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 Australian and New Zealand College of Psychiatrists (RANZCP) has implemented a new competency based Fellowship Program. New trainees commencing in Australia from January 2013 will train under the new program, while existing trainees who will finish by the end of 2015 will complete training under the previous 2003 program. The new program provides that trainees must gain competence in a range of major roles of a psychiatrist: medical expert, communicator, collaborator, manager, health advocate, scholar and professional. Training will typically be 60 months, over three stages:

  • Stage 1 (12 months): Basic level adult psychiatry.
  • Stage 2 (24 months): Proficient level, mandatory and elective rotations.
  • Stage 3 (24 months): Advanced level including elective rotations, certificate of advanced training programs available.

Please refer to the RANZCP website for further information.

https://www.ranzcp.org/Pre-Fellowship/2012-Fellowship-Program.aspx

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) introduced a revised Training Program for trainees commencing on or after 1 December 2013. Major changes that now apply to both new and current trainees include:

  • the first 4 years of training are known as Core Training; the final 2 years are known as Advanced Training;
  • training time is calculated in weeks; one year = a maximum of 46 weeks;
  • training can be any fraction equal to or greater than 0.5 FTE, provided it is approved by the employer and prospectively approved by RANZCOG;
  • the 3-month report is a formative appraisal and must be submitted within 4 weeks of the end of the relevant training period. The ‘Warning’ component has been removed;
  • the 6-month report is a summative assessment and must be submitted within 6 weeks of the end of the relevant training period. The ‘Borderline’ is no longer available; and
  • each 6-month period will be assessed as either ‘satisfactory’ or ‘unsatisfactory’. Unsatisfactory means the 6-month period is not credited.

Other major changes have been introduced that apply only to new trainees who have commenced or commence their FRANZCOG training on or after 1 December 2013.

The Royal Australasian College of Physicians (RACP) developed a new training program, ‘Physician Readiness for Expert Practice’ (PREP), which was progressively phased in through 2008 in Basic Physician Training and through 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 came 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 specialty is outlined in Appendix B.