Medical Training Review Panel 19th Report

Background

In order to satisfy MBA registration requirements, interns undertake a series of rotations to enable them to experience a range of clinical situations and service environments. These rotations must be accredited in accordance with guidelines developed by the state and territory postgraduate medical councils or medical education and training units. These placements must ensure adequate case-mix, service, teaching, supervision and assessment.

Most junior doctors work for at least one, and often two or more years after their intern year in the public hospital system and community health services to gain more clinical experience with greater levels of responsibility prior to commencing a vocational training program. An important goal of this experience is to consolidate the clinical skills developed during university training and the intern year, and to equip junior doctors with the prerequisite experience and procedural skills for entry into specialist or vocational training programs.

Generally, training at the prevocational level involves rotating between clinical departments in regional and urban public hospitals with some training in community settings, including general practice. Rural locations are also available. The rotations are intended to give junior doctors experience of a broader range of clinical settings, and meet service delivery needs. After introduction of Additional Medical Internships initiative in 2013, intern training was extended to the private sector.

Although a number of specialist medical colleges may accept entrants to vocational training programs directly following completion of postgraduate year 1, most prefer applicants to have completed a second or even third year of prevocational training (PGY2 and PGY3). Doctors in this period of prevocational on-the-job training are usually referred to as ‘Resident Medical Officers’ (RMOs). The term ‘Hospital Medical Officer’ (HMO) is used in Victoria, ‘Junior Medical Officer’ is used in NSW, and ‘Trainee Medical Officer’ (TMO) in South Australia.

Not all doctors will enter vocational specialist training in their fourth postgraduate year (PGY4). Some may enter vocational training specialty at a later stage (PGY5+), but others may leave the medical workforce, pursue a research career, choose to work as locums or continue to work in hospital settings in a non-vocational career role, typically as Career Medical Officers (CMOs). Most CMOs work in hospital settings, and a number of CMOs acquire other postgraduate qualifications related to their roles, such as early management of severe trauma, advanced paediatric life support or emergency life support.

When interpreting and analysing these prevocational data, caution is needed. This is because the numbers presented are sometimes estimates, with administration systems often not capturing data in a way that matches the breakdown of information for MTRP reporting purposes. Consequently, the number of trainees, particularly PGY2 doctors, may be an underestimate. Also, some states and territories have different prevocational training processes. For instance, in New South Wales, trainees are employed on two year contracts covering both PGY1 and PGY2 training. As a result, the number of PGY2 positions advertised each year does not reflect the total number of PGY2 positions available.