Medical education in Australia
In the United States, there are no pre-vocational terms, whereby specialty selection during Internship ensures streamlined clinical rotations for that intended specialty pathway, and thereafter, enrolment and progression onto a Residency program towards achieving specialist board certification; therefore, Residency in the United States is equivalent to a Registrarship in Australia.
Most of the specialist fellowship qualifications and medical school degrees awarded to Australian-trained clinicians are internationally recognised.
Applicants apply directly to the medical school and/or through the statewide facilitated university course placement program.
[1][2][3] Most medical schools follow a similar education program, which includes essentially two phases: Most learning is multi-modal and include traditional didactic learning through lectures, workshops, seminars, clinical simulation and tutorials, group-based tutorials such as Case-Based-Learning (CBL) or Problem-Based-Learning (PBL), in addition to any hospital facilitated educational activities.
Assessments commonly include a mixture of written (MCQ, EMQ, short and long answer) and clinical exams (OSCE) at the end of each term or unit.
It allows medical graduates to consolidate and apply clinical knowledge and skills while taking increasing responsibility for the provision of safe, high quality patient care.
[9] Applications for internships are typically coordinated by the relevant State Government's Health Department through an annual recruitment campaign.
Applicants have the opportunity to preference the district and/or hospital(s) they wish to be employed at, and are selected based on a combination of a ballot-based and merit-based system.
In contrast to medical education following the United States system, internship and residency in Australia are considered pre-vocational terms where doctors have yet to formally commence their training in a specific speciality.
[11] While some specialist medical colleges accept entrants after successful completion of internship or postgraduate year 1 (PGY-1), most prefer applicants to have completed at least a further 2 to 3 years (or more) of pre-vocational training at the level of a resident (PGY-2 to PGY-3 or more) in order to have gained sufficient additional clinical experience prior to applying for a specialist training program.
Clinical rotations and terms are at the preference of the resident (and dependent on the availability of the health service); there are no mandatory terms to fulfill; for example, if the resident has aspirations to pursue enrolment in surgical speciality training, they would preference and request more rotations in the various surgical specialties (for instance, Neurosurgery, Cardiothoracic, or Urology), versus if the resident had interests to pursue emergency medicine, he or she would probably benefit from further rotations in the various critical care specialties (that is, Intensive Care Medicine, Emergency Medicine, or Anaesthetics).
[8] Whilst the Medical Board no longer requires performance reports to be submitted directly to them, it mandates and delegates the responsibility to the relevant hospital administration, post-graduate medical councils and speciality colleges, to ensure the continual support, education and teaching of their residents (and registrars) as well as ensuring routine performance reviews and term reports from senior clinicians supervising their practice.
It is a period of on-the-job training and assessments in order to qualify for fellowship of one of the recognised specialist medical colleges, which allows a doctor to practice medicine independently and unsupervised in that relevant speciality field, and with this access to an unrestricted Medicare provider number and Medical Board specialist registration.
Nowadays, most colleges require applicants to have previous clinical supervisors submit referee reports, and fulfil a number of criteria in their curriculum vitae (CV) which typically involve scoring the candidate in four domains: Applicants with satisfactory CV are invited to partake in interviews or assessments that typically assess adequate medical knowledge to commence speciality training and explore psycho-socially if the candidate if suitable for the speciality.
Specialist training programs and examinations are administered by the individual colleges and vary between three and seven full-time years to complete, depending upon the speciality you choose.
[12] Registrars are nonetheless employed and remunerated by the hospital at which they work for; and thus, are still required to submit an application for a position through the recruitment campaigns coordinated by the relevant State government's ministry of health.
As aforementioned, Residents in the Australian medical system are doctors who have completed internship and undergoing additional years of general clinical rotations to gain further experience, prior to enrolling into a specialty training program.
Doctors who choose to take up the role of an unaccredited registrar are typically those: In Australia, the Australian Medical Council has recognised 16 medical speciality colleges responsible for the continued education, training, and accreditation standards of their respective specialities: (Formal, Informal) Emergency specialist Anaesthetist Pain doctor Pain specialist Rural generalist Rural general practitioner (GP)
Traditionally, career medical officers or hospitalists are employed as permanent full-time or part-time staff, but more commonly in recent times, due to a significant workforce of clinicians been in-flux with their specialty training and insufficient staffing of middle-grade clinicians at hospitals, there has been an increase supply and demand for career medical officers on a locum tenens or casual basis.
Dependent on their place of employment and duties, the responsibilities and remuneration of non-specialist career medical officers are usually comparable to somewhere between registrars and consultants.
Similar to other specialties, those wishing to continue to practice in the specialty field of General Practice are required to attain a Fellowship of the Royal Australian College of General Practitioners (FRACGP) or Fellowship of the Australian College of Rural and Remote Medicine (FACRRM).
Whilst most specialist medical practitioners take the opportunity to pursue private practice, many of them (with the exception of a majority of GPs) continue to work at least part-time as salaried employees in the state public hospitals.
A properly trained and qualified General Practitioner (GP) should be able to independently assess, diagnose and treat a wide variety and range of illnesses within their scope of practice prior to referral to their non-GP specialist colleagues.
Most urban GPs work in community-based clinics and deliver predominantly primary care, with a subset of regional or rural GPs additionally working in public hospitals to deliver emergency or secondary care where there is a shortfall of non-GP specialist medical practitioners.
It is not uncommon for GPs to also complete extended skills training to broaden their clinical scope of practice; insofar that it is encouraged and typical for GPs to proceed to attain formal accreditation in advanced areas of clinical practice (such as a GP who has postgraduate diplomas and accreditation to provide anaesthesiology or obstetric services) and/or formally complete additional fellowship in another specialty field of medicine (such as a GP who is also qualified as a public health physician or palliative care physician).
The Royal Australian College of General Practitioners (RACGP) and Australian College of Rural and Remote Medicine (ACRRM) are responsible for the accredtiation, education and training of GPs in Australia; medical practitioners who complete the registrar training program are awarded a Fellowship of RACGP (FRACGP) and/or Fellowship of ACRRM (FACRRM) and recognised as Specialists in the field of General Practice.
Medicare also makes this delineation for the purposes of appropriately allocating referrals, rebates and billings amongst GPs versus non-GP 'Specialist' Consultants.
Medical practitioners who could demonstrate that they practiced for at least 5 years in General Practice prior to 1995 were not required to complete a specialty training program nor required to be awarded a fellowship by RACGP or ACRRM in order to be recognised as Specialist GPs by AHPRA and Medicare; these GPs were effectively 'grandfathered' onto the vocational/specialist register.
Similarly, Career Medical Officers and Registrars financially enrolled in a specialty college as non-fellow or trainee member may also partake in the CPD program and educational activities, some of which are highly recommended or mandatory.
From 2023, AHPRA and MBA has mandated that CPD must consist of at least 50 hours, which is made of the following components: Mandatory education activities typically require the clinician to participate in activities that ensures ongoing up-to-date competency and receive feedback on core skills and clinical knowledge related to their scope of practice.
