RANZCOG and specialist international medical graduates – what progress has been made?

A previous article in O&G Magazine (Winter 2011, p74–76) described the processes by which international medical graduates (IMGs) with specialist qualifications obtained in countries other than Australia or New Zealand are assessed for comparability/equivalence to an Australian- or New Zealand-trained specialist.

The similarities and differences of the processes in both countries were described, along with an outline of considerations that need to be taken into account by the College when undertaking such assessments. The article acknowledged the complexity associated with this aspect of College activity and made reference to the Australian House of Representatives inquiry into overseas trained doctors that had yet to report at that time.

The report of that inquiry, titled ‘Lost in the Labyrinth’, was handed down in March 2012 and contained 45 recommendations intended to improve the efficiency and transparency of processes associated with the assessment and registration of IMGs (both specialist and non-specialist) in Australia. The report may be accessed online at: www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=haa/overseasdoctors/report.htm.

Part of the committee’s deliberations related to ‘the provision of professional and personal supports for IMGs and their families’, writing that ‘access to these types of supports is not only crucial to the initial recruitment of IMGs, but also to rates of retention’, and noting: ‘The committee’s recommendations seek to enhance and strengthen existing systems of support, including pre- and post-arrival orientation, access to professional development opportunities and peer support networks for IMGs, and access support networks for spouses and children.’ Further, the report made the point that: ‘in formulating the report’s 45 recommendations the fundamental aim has been to reduce red tape, duplication and administrative hurdles faced by IMGs, whilst ensuring that the Australian standard [of healthcare] continues to be applied.’

Of the 45 recommendations, a number applied to issues relating to IMGs seeking general registration, while others applied only to those seeking specialist registration, with some having applicability to both groups. Similarly, some recommendations had direct relevance to the specialist colleges, either solely or in conjunction with other bodies, such as the Medical Board of Australia (MBA), the Australian Medical Council (AMC) and Health Workforce Australia (HWA).

To this end, following the release of the report, a working group involving representatives from the MBA, AMC and the Committee of Presidents of Medical Colleges (CPMC) was convened to examine the recommendations and respond to government in relation to way(s) in which relevant aspects of the assessment and registration of IMGs seeking specialist recognition could be improved. One significant outcome of the activity of the working group was a recommended set of refinements to the processes associated with the overall specialist comparability assessment, which should result in a reduction of administration requirements through a streamlining of the application process, including the manner in which documentation is received and distributed, in order to enable the different parts of the overall process to occur as efficiently as possible.

A number of recommendations contained within the Lost in the Labyrinth report relate to support for IMGs, particularly in relation to orientation within the Australian healthcare system, as well as the provision of adequate, appropriate clinical supervision placements. Both of these aspects are high on the list of College priorities of mechanisms to assist IMGs working towards College Fellowship, and much has been done over time to provide appropriate, high-quality online materials to assist the former. All applicants for specialist IMG (SIMG) assessment who are determined as being eligible to progress to the interview phase of the assessment process are provided with a personal login that enables access to all materials available to RANZCOG ITP Trainees, including the full suite of CLIMATE education modules.

For SIMG applicants assessed as partially comparable to an Australian-trained specialist, as part of the Commonwealth’s Specialist Training Program, funding has been made available through the College to assist with attending courses and workshops that are identified as being able to help individuals to address identified upskilling needs. Such needs are identified during assessment by the College, as well as through consultation between the partially comparable SIMG and their Training Supervisors. The College SIMG Training Portfolio can be used to match upskilling needs with resources, with approved funding able to be used for training (workshops, seminars, clinical training and so forth) and associated travel and accommodation costs. Further information in relation to this funding initiative may be found on the College website at: www.ranzcog.edu.au/partially-comparable/additional-information/funded-training.html . Workshops offered by the College and tailored to assist SIMGs as they work toward their Fellowship, include An Introduction to the Australian Health Care System and Effective Communication Skills.

Factors surrounding the securing of suitable sites with appropriate oversight or supervision and training/upskilling to ensure SIMGs meet the requirements necessary for recognition as a specialist in obstetrics and gynaecology in either Australia or New Zealand are not simple. In neither country is the College an employer of medical workforce, nor does it have a role specifically in acting as an intermediary between employers and individuals seeking to obtain employment that will offer the necessary clinical (and non-clinical) opportunities that may be required. The situation is further complicated in Australia by the existence of Federal and State workforce initiatives designed to address workforce shortages through Area of Need and Districts of Workforce Shortage identification, and in New Zealand where applicants for SIMG assessment may be employed in positions requiring a range of skills over and above that held by the practitioner prior to their assessment by the College in its role as a Branch Advisory Body for the Medical Council of New Zealand.

The Lost in the Labyrinth report contained multiple recommendations in relation to the areas of orientation and supervision of SIMG applicants and the reference to recommended collaboration between multiple stakeholders illustrates both the importance of this matter, as well as the complexity. The long-held view of the importance of ensuring the least prepared individuals do not get placed in the least supported and potentially clinically high-risk environments seems to have been voiced to and heeded by the committee, and the College seeks to ensure that appropriate supervision arrangements that will support both the SIMGs whom it has assessed and the communities that they serve are in place for all individuals.

The awareness that this extends to the training and support of those responsible for supervision and/or oversight requirements is also understood and the College is constantly looking for ways in which to improve aspects of the process applicable to these individuals, including the provision of College workshops to address the specific needs of the people undertaking these roles.

The above notwithstanding, the College, through the SIMG Assessment Committee, is aware of the need to continue to improve the support mechanisms provided to IMGs seeking recognition as specialists in O and G, and who are progressing to that status following assessment by the College. Much has been accomplished in recent years to align processes used by the College across the two countries it serves, as well as to ensure that thorough, accurate information is available to potential applicants, including in relation to the fees associated with the assessment processes and the ability to request reconsideration, review and appeal of College decisions. Assessment processes have been refined and significantly altered to ensure that requirements reflect the variable experiences and capacities of individual practitioners, as well as ensuring that candidates are given the opportunity to demonstrate the breadth, depth and range of their training and experiences, and the move toward workplace-based assessment methodologies is clear.

On an overall basis, both Australia and New Zealand have a significant proportion of IMGs in the workforce that delivers medical services, particularly in the regions that may be considered rural or remote. The extent to which this reliance may be lessened in the future through government initiatives in either country, is, at this point, unknown. Indeed, both countries are training more medical graduates (albeit to differing extents), and these increased numbers of locally trained primary medical graduates can logically be expected to lead to increased numbers of locally trained specialists, with possible pressures resulting that may see changes in workforce distribution of locally trained specialists, in addition to changes simply in workforce numbers.

The College is aware of the importance of both specialist and general registration IMGs to the medical workforce of Australia and New Zealand, and the associated importance of ensuring the nurturing and support of these individuals to ensure they are able to practise in a clinical environment where they are supported both professionally and personally in a manner that enables the delivery of women’s healthcare to the standard expected by the communities of Australia and New Zealand. All aspects of all programs offered by the College are constantly examined to determine ways in which they can be improved for users, and the assessment and training programs offered by the College in relation to SIMGs are no exception.

While no one would claim that all that is able to be done has been done, the College has made significant commitment and progress over time to ensuring that it is aware of all developments that affect this area of its functions, and to adjust processes and requirements to reflect this, and will continue to do so. This includes working with government and other stakeholders, as well as being proactive to ensure that internally initiated improvements in relation to this group of practitioners continue to be made.