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THE push for a national rollout of the workplace-based assessment program for international medical graduates has been reignited following the release of research detailing the relatively low costs associated with delivering the program.
In a study published in the MJA, University of Newcastle researchers found that the net cost of providing the 6-month workplace-based assessment (WBA) program to international medical graduates (IMGs) was “small” at $10 226 per candidate after accounting for the $6000 fee paid by each candidate. (1)
Dr Viney Joshi, Australian Doctors Trained Overseas Association president, said he “wholeheartedly” supported national expansion of the WBA program.
“The jury has been out on the AMC [Australian Medical Council] exam for a fair while”, Dr Joshi told MJA InSight. “We are trying to certify doctors for their safety and competence to practise in the Australian system and whether their knowledge and credentials are up to date from that perspective,” he said, adding that the workplace is the best place to achieve these aims.
The WBA comes under the AMC’s standard pathway, allowing some IMGs to be assessed by AMC-accredited authorities. Currently just seven authorities have accreditation. The program tracks the performance of IMG candidates in everyday practice and assesses how well they deal with patients and work with other health professionals. (2)
The WBA program has been found to be a feasible and acceptable alternative to the AMC clinical exam. (3)
Lead author of the latest MJA study, Professor Kichu Nair, told MJA InSight the research “absolutely” provided sufficient evidence to support a national rollout of the program.
“It costs only around $10 000 to assess a doctor and make them safer — a very small price to pay for a long-term investment [in a] a doctor who is going to work in the Australian health system for 20–30 years”, said Professor Nair, director of the Centre for Medical Professional Development, Hunter New England Local Health District and associate dean of the University of Newcastle’s School of Medicine and Public Health.
Dr Joshi agreed that the WBA program could be a cost-effective option, particularly when considering that some IMGs may have to take the AMC exam multiple times.
At the time of the study, all 95 candidates who had completed the Newcastle WBA program passed, compared with a 50% pass rate with the traditional assessment pathway.
Professor Nair said this was despite the Newcastle WBA program being a more rigorous performance assessment.
Professor Nair said the improved pass rate was a result of candidates working as doctors, gaining exposure to the Australian health care system and the “constant and constructive feedback” provided in the program.
“Every time [candidates] go for an assessment, whether or not they pass or fail, they get feedback as to how to improve the next time”, Professor Nair told MJA InSight.
Dr Joshi said it was crucial that the WBA assessors were drawn from a wider pool of clinicians than was the case with the AMC exam, which often relied on the expertise of “super-specialists”.
“This is not meant to be a postgraduate exam. This exam is supposed to be at an undergraduate level, so [the examiners] need to be appropriate, practising clinicians of similar capability”, he said.
In 2012, the Lost in the labyrinth report resulting from the House of Representatives Committee Inquiry into Registration Processes and Support for Overseas Trained Doctors recommended that WBA be further evaluated and expanded nationally. (4)
A spokesperson for the federal Minister for Health Peter Dutton said the Lost in the labyrinth report was directed to the former government and government agencies. The current federal government would consider the report, the spokesperson said.
Professor Nair said since the WBA program’s inception in 2010 about 200 practitioners had accessed the program, with more than 115 assessments provided by the Newcastle program.
1. MJA 2014; 200: 41-44
2. Australian Medical Council. Workplace-based assessment (standard pathway).
3. MJA 2012; 196: 399-402
4. Australian Government. Lost in the labyrinth: report on the inquiry into registration process and support for overseas trained doctors. 2012.
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Three trainee psychiatrists and an intern working in Victorian hospitals died suddenly in recent weeks, sparking concern about the intensity of their training programs and the overburdened health system they are working in.Dr Haikerwal, a Victorian GP and chairman of the World Medical Association Council, said after talking to psychiatric trainees in Victoria over the weekend, he was concerned about a low pass rate in their training program and the workload they faced in the stressed public hospital system. http://www.smh.com.au/national/health/three-victorian-psychiatrists-deaths-raise-questions-over-intense-training-program-20150202-133m75.html
How many IMGs actually remain in areas of neeed? If they do not remain in areas of neeed, are they needed?
Jackie – I presume the psychiatrists are here under the Area of Need Specialist Pathway. Surely if the need persists, and the RANZCP considers that their qualifications and relevant experience meet the specified requirements of a particular area of need position, then they are still needed and can continue working as pyschiatrists in the area of need.
As a person who lives, works and accesses mental health services in rural and remote Australia, I am most concerned about the ongoing complex, confusing and disadvantage that the report talks of regarding Overseas Trained Specialists, in this case I refer to psychiatrists;
Via my work with families and consumers in mental health I see first hand the devastating consequences to both them and our communities by not having access to psychiatrists in rural and remote areas of Australia.
I have been asking the politicians, mental health peak mental health advocates organisations and to come together to assist with the issue. With the exception of RANZCP (who were helpful). The result has been silence.
This matter is now urgent for rural and remote mental health services and in particular, Victoria who is at high risk of loosing over at least 40 Overseas Trained Specialists in psychiatry this year.
I understand from your article that the current federal government will consider the report. Even if they do consider the report today and act on it – it could be too late for many psychiatrists this year. who after working for many years will have to make a choice to leave their position and find a new career or leave the country and practice elsewhere in the world. either way everyone looses.
We need IMGs in rural and remote areas where there are crucial shortages. We need them in outer metropolian areas for similar reasons. HWA data suggests that we need them till 2025 .
Why do we need IMGs when we cannot place our own interns?
The local graduates are brought up in the system. They know how to communicate with patients; they know the Australian health care system welll. I agree that IMGs are a heterongenous group of doctors with varying skills and competencies. At least the local graduates are assessed in the local system by the local clinicians. The public and the medical profession should be reassued the IMGs have been assessed to see they are safe to practise here. I have gone though the IMG system and I am glad I did it , so that no body can think that I took the easy way out.
The WBA is a better assessment than the current clinial exam.
“It costs only around $10 000 to assess a doctor and make them safer “.
I think this is a reasonable statement with general application, most of us could probably do better following six months supervision, regardless of our underlying competence. Bad habits easily develop, along with false assumptions and sloppiness. But surely Dr Joshi is incorrect – these are tests of fitness to practice, not the level at which a graduate is fit to enter into post graduate traing to become fit to practice unsupervised?
“It costs only around $10 000 to assess a doctor and make them safer “. That statement assumes a lot, specifically that an IMG is less safe than an Australian graduate. I think this assumption is flawed and somewhat arrogant and disrespectful. This country deals with a mixed bag of overseas trained doctors, some of whom are of superior skills and competencies to the average Australian graduate, some of whom are equivalent and some have inadequate skills and indeed need upskilling or simply cannot be accepted as equivalent.
The automatic assumption that IMG’s need to be “upskilled” is a bit insulting. Having had a lot to do with educating young Australian graduates in the last 10 years, as well as many years of teaching medical students, I can say that the standard of knowledge of medical graduates here is far from brilliant. There is more and more ignorance about topics that were standard knowledge when I went to medical school (overseas!) and this is wrapped with educationalist ideology about “problem based learning”, which, if anything, is “problematic learning”. Topics such as pathology, pharmacology and physiology, not to mention anatomy are no longer thoroughly and systematically taught. They still are being taught in many “old fashioned” overseas medical schools that have not yet adopted destructive new age educationlist philosophies. Let us all be a bit more modest before labelling others with incompetence.
WBA is a good idea – more practical than a simple exam.
But more fundamentally, before WBA or exams, we first need to ensure that all doctors who wish to practice in Australia meet the standards of entry that apply to Australian medical students – ie pre-medical school academic record, UMAT/GAMSAT result, and interview.
Internationally, and across all or most fields of occupational endeavour, capability is what employers are looking for. That doesn’t mean exams and qualifications aren’t important, but that they are not enough on their own. Training programs – rather than education programs – have always known that.
IMGs are not the same as AMGs just out of their medical school or prevocational years. Neither are GPs who have been practising for many years. Script concordance shows us we learn to practise differently – we can use this in WBA to better assess the experienced IMG.
Further, WBA gives our communities – often the most remote and vulnerable communities – equity. Communities where IMGs have passed WBA know their medical carers are just as competent – or more so – as medical carers anywhere else. Those communities know they get safe quality care – like anywhere else.
ACRRM and others have shown this method is great value for effort and funds – not just for the IMGs but for their communities. This is a good investment all round.