NEW SOUTH WALES MEDICAL BOARD POLICY Internship and AMC Supervised Training
TITLE
FILE REF
96/125 96/129
NUMBER
R7.6
MPA REF
Sections 4& 5
DATE CREATED
11 December 2006
RELATED POLICIES
REVISIONS
10 April 2007, 18 September 2007, 18 December 2007, 17 June 2008
INDEX:
Page
Legislation
2
Policy 1.
Interns
1.1 1.2
1.3
Graduates of accredited Australian and New Zealand Medical Schools Placement & Term Allocations 1.2.1 Emergency Department Terms 1.2.2 Relief Terms 1.2.3 Rotation Terms Completion of internship
2.
Supervised Training
2.1 2.2 2.3 2.4
Australian Medical Council Certificate holders Placement and term allocations Upgrading supervised trainees Waiver of supervised training period
4 4 4 5
3.
Part time Internship or Supervised Training
5
4.
Deferral of Internship or Supervised Training
5
5.
Unsatisfactory Progress
5
5.1 5.2 5.3
Registration for Internship or Supervised Training is Limited Extension of Registration for Internship or Supervised Training Withdrawal of Registration
6 6 6
6.
Pathway
6
Policies - Registration
2 2 3 3 3 3
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NSW Medical Board Internship and AMC Supervised Training
LEGISLATION 4. ENTITLEMENT TO GENERAL REGISTRATION BASED ON QUALIFICATIONS AND TRAINING
(1)
(2)
(3)
5.
A person is entitled to be registered as a medical practitioner if the person has recognised medical qualifications and has successfully completed a period of internship or supervised training as required by the Board. A person has recognised medical qualifications if the person is a graduate of a Medical School (whether within or outside Australia) accredited by the Australian Medical Council or has successfully completed examinations held by that Council for the purposes of registration as a medical practitioner. The entitlement under this section is an entitlement to general registration (that is, registration not subject to any condition).
ENTITLEMENT TO REGISTRATION WITH CONDITIONS FOR INTERNS (1)
(2)
A person is entitled to be registered as a medical practitioner subject to appropriate conditions if the person would be entitled to registration under Section 4 except for the fact that he or she has not completed a period of internship or supervised training required by the Board The appropriate conditions of registration are such conditions as the Board thinks appropriate for the purpose of enabling the person to complete that internship or training
POLICY
1. INTERNS 1.1
GRADUATES OF ACCREDITED AUSTRALIAN AND NEW ZEALAND MEDICAL SCHOOLS Graduates of medical schools accredited by the AMC are eligible to undertake an internship in NSW. These graduates are entitled to registration with conditions for interns. Interns are only permitted to work in hospitals that meet NSW Institute of Medical Education and Training (IMET) accreditation standards and can only work in terms accredited by IMET. By agreement with the Board, IMET manages the accreditation of hospitals for internship and oversees the process of hospital certification of satisfactory performance by interns.
1.2
PLACEMENT AND TERM ALLOCATIONS The allocation of graduates to intern positions is undertaken by IMET. Interns are allocated to a prevocational training network. One hospital in the network is nominated as the home hospital, (a hospital within the allocated network where the trainee will spend the majority of their training, i.e. three or more terms).
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Allocation to a prevocational training network is for two years in order to encompass internship and RMO1 (Registered Medical Officer 1) year. The internship consists of 5 terms (usually of ten weeks duration). All interns must undertake a term in medicine, surgery and emergency medicine (known as core terms). All interns are required to complete at least three terms at their nominated hospital within the network. The other two terms may be done at any one or more of the rotation hospitals within the hospital network with the expectation that one will be a rural rotation (where one exists). 4 weeks of annual leave is permitted during the Internship but no more than one week should be taken during any core term. Periods of annual leave longer than one week should be taken during a non-core term such as the Relief term. Annual leave must be clearly recorded in the Certificate of Hospital Service or term report in which the leave was undertaken. As per IMET standards, the terms must be supervised to a degree commensurate with the intern’s level of training and experience, and should have a general educational content suitable to the level of training and experience of the intern. 1.2.1 EMERGENCY DEPARTMENT TERMS The Emergency Department term provides interns with the broadest range of experience and is a good discriminator of performance, but it may not be the appropriate first term placement for an intern experiencing difficulties. In allocating terms, hospitals should attempt to identify those interns who would benefit from completing other terms first and endeavour not to place them in the Emergency Department in their first term. 1.2.2 RELIEF TERMS Relief terms are often characterised by suboptimal orientation, variable supervision arrangements and uncoordinated reporting. A relief term is not recommended as a first term placement for an AMC supervised trainee who is unfamiliar with the Australian healthcare system. Similarly, it may not be an appropriate allocation for a trainee (AMC supervised or intern) who has demonstrated performance difficulties in previous terms. In allocating terms, hospitals should attempt to identify those trainees (AMC supervised or interns) for whom a relief term is undesirable. In these circumstances, a relief term may not count towards the Board’s requirements. 1.2.3 ROTATION TERMS A rotation term may not be the appropriate first term placement for an intern experiencing difficulties because of the likelihood that supervision may be inconsistent. In allocating terms, hospitals should attempt to identify those
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interns who would benefit from completing terms at the home hospital before being sent to a rotation hospital. 1.3
COMPLETION OF INTERNSHIP The Board must be satisfied that the internship has been completed satisfactorily before it can consider entitlement for general registration. The Board requires a Certificate of Hospital Service from the home hospital evidencing successful completion of the period of internship. Time spent at both the home hospital and the rotation hospitals should be documented, including the disciplines in which the rotations have been served. Details of any aspect of the intern's service deemed to be unsatisfactory should be documented by the home hospital. The home hospital must ensure that it has gathered sufficient information from rotation hospitals to enable proper completion of the Certificate of Hospital Service. The Board will also consider entitlement to general registration for graduates of AMC accredited medical schools who have satisfactorily completed a recognised internship in another State or territory in Australia or in New Zealand. If such a graduate has completed an internship other than in Australia or New Zealand, the Board may require the applicant to undertake a period of supervised training, prior to general registration being considered.
2. SUPERVISED TRAINING 2.1
AUSTRALIAN MEDICAL COUNCIL CERTIFICATE HOLDERS Doctors who have passed the Australian Medical Council (AMC) Examinations are required to undertake a period of supervised training. These doctors are entitled to registration with conditions for the period of supervised training. The purpose of the supervised training is to ensure that the doctor is familiar with local health care delivery systems and attains a level of clinical competence equal to that of graduates of medical schools accredited by the AMC. The period of supervised training is usually 12 months. Supervised training is generally undertaken in hospitals that meet IMET accreditation standards, but may be undertaken in other settings where appropriate. In such circumstances the Board must be satisfied of the appropriateness of the training program and the level of supervision. At the commencement of supervised training, the doctor should be supervised in all clinical activities as if an intern, and should not be responsible for the supervision of the clinical activities of other junior doctors.
2.2
PLACEMENT AND TERM ALLOCATIONS The allocation of AMC graduate doctors to supervised training positions is undertaken by IMET. The Board authorises IMET to allocate AMC graduate
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doctors using the same criteria as apply to graduates of AMC accredited medical schools undertaking internships. The same term allocation criteria that apply to graduates of AMC accredited medical schools undertaking internships apply to the AMC graduate doctor. The AMC graduate doctor must satisfactorily complete five terms including a term in medicine, surgery and emergency medicine (known as core terms) and complete terms at rotation hospitals within the allocated hospital network. 2.3
UPGRADING SUPERVISED TRAINING The home hospital, after having reviewed the AMC graduate doctor's performance, may apply to the Board to place the doctor in a term accredited by IMET as suitable only for doctors having completed an internship.
2.4
COMPLETION OF PERIOD OF SUPERVISED TRAINING The Board must be satisfied that the period of supervised training has been completed satisfactorily before it can consider entitlement for general registration. The Board requires copies of all term reports and a letter of recommendation for General registration from the Director of Prevocational Education and Training (DPET) at the home hospital evidencing successful completion of the period of supervised training. Time spent at both the home hospital and the rotation hospitals should be documented, including the disciplines in which the rotations have been served. Details of any aspect of the AMC graduate doctor's service deemed to be unsatisfactory should be documented by the home hospital. The home hospital must ensure that it has gathered sufficient information from rotation hospitals to enable proper completion of the certificate of hospital service.
2.5
WAIVER OF THE SUPERVISED TRAINING PERIOD The Board may consider waiving the supervised training requirement partially or completely if the AMC graduate doctor has had appropriate clinical experience in Australia.
3. PART TIME INTERNSHIP OR SUPERVISED TRAINING The internship and the period of supervised training can be undertaken on a part-time basis, subject to the following criteria: -
-
the aggregate number of hours worked is the same as that required of those completing an internship or period of supervised training on a fulltime basis; the range of work and shifts undertaken provide an equivalent exposure to varying clinical circumstances and patterns; the total time taken does not exceed three years; and
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NSW Medical Board Internship and AMC Supervised Training
-
there is a full-time component for at least one term of 10 weeks duration (usually completed at the commencement of the internship or period of supervised training).
4. DEFERRAL OF INTERNSHIP OR SUPERVISED TRAINING The internship or period of supervised training can be deferred. Anyone contemplating deferral should be aware that they will not necessarily be able to automatically resume their internship or period of supervised training at the point they deferred. They may be required to attend an interview at the Board to determine eligibility for registration to resume practice, and in determining eligibility for registration the following issues will be considered: • The period of time elapsed since completion of their degree or AMC examinations; and • Subsequent study and / or employment. They may be required to undertake formal assessment, such as the AMC Multiple Choice Question examination before being able to resume their internship or period of supervised training.
5. UNSATISFACTORY PROGRESS 5.1
REGISTRATION FOR INTERNSHIP OR SUPERVISED TRAINING IS LIMITED Registration to undertake internship or supervised training is granted for defined periods of time. Twelve months is the usual period allocated for preparation for general registration. At the end of twelve months, the majority of interns and AMC graduate doctors will progress to general registration. This is not automatic, but depends on having demonstrated satisfactory performance and progress.
5.2
EXTENSION OF REGISTRATION FOR INTERNSHIP OR SUPERVISED TRAINING A very small number of doctors are unable to satisfy the home hospital and the Board that they should be granted general registration after the initial 12month period of internship or supervised training. Doctors may require more than twelve months’ supervised experience to achieve general registration. There is no automatic entitlement to extension of registration with conditions for internship or supervised training. The Board will consider additional periods of registration with conditions if the doctor has demonstrated progress and has a suitable job offer in an IMET accredited position. Where extension is granted, it will be for a specified period and will generally be linked to the number of additional terms required.
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Terms undertaken on a “supernumerary” basis will not be counted in assessing progress to general registration unless the hospital certifies that the registrant has been required to undertake all the normal duties and workload of an Intern/Supervised Trainee, and has been assessed as satisfactory at the completion of the term. 5.3
WITHDRAWAL OF REGISTRATION While most doctors are able to satisfactorily complete their internship or supervised training with the completion of additional terms, there cannot be an open-ended approach to the completion of an internship or supervised training, as this would encourage unrealistic expectations in the doctor and create difficulties for employers. Hospitals are encouraged to contact the Board at the earliest opportunity if progress is unsatisfactory, rather than leaving it until the end of the period of internship or supervised training. The Board will withdraw registration at the conclusion of the extension period unless the required standard for general registration has been met, or a further extension is warranted in accordance with these principles.
6.
PATHWAY
1. 2. 3.
BASIC TRAINING SUPPLEMENTARY I SUPPLEMENTARY II
-
12 months up to 3 (10 week) terms up to 2 (10 week) terms 2 YEARS
PROGRESSION TO GENERAL REGISTRATION FOR INTERNS/AMC
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At conclusion of registration period
Not satisfactory, no job offer
Not satisfactory but progressing and suitable employment offer
Registration lapses
Register for further time-limited period
May apply for further time-limited registration if offered suitable employment – normal registration criteria apply.
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Satisfactory – General Registration
