Medical Training Review Panel 19th Report

Vocational Medical Training in Australia

Following completion of university medical education and the 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 a number of training programs and a network of Regional Training Providers. The training programs are accredited by the Australian Medical Council (AMC).

The AMC is an independent national standards body for medical education and training. The AMC 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. The jurisdictions and health services work with the medical colleges to address particular challenges, such as improving trainee supervision in public hospitals, developing statewide training programs and addressing the need for generalists or sub/super specialists. They also offer the training posts/facilities 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 individual’s 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 recognition that training needs to better reflect where healthcare is delivered, have seen an expansion over the last few years of specialist training positions to private hospitals and community settings.

All specialist colleges now assess their trainees at multiple time-points during training with a range of assessment techniques. Most colleges use written, oral and/or clinical examinations and the majority have an exit examination. A range of other in-training assessments of both a formative and summative nature are also utilised, so that the full range of knowledge, skills and behaviours, including communication, team work and other forms of professional behaviour, 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.