On-the-job certification for IMGs gains traction

A more hands-on approach to certifying international medical graduates is gaining wider acceptance

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A more hands-on approach to certifying international medical graduates is gaining wider acceptance

A program to certify international medical graduates to practise in Australia on the strength of workplace assessments, rather than a single clinical exam, is finding wider acceptance after a success in the NSW Hunter region.

In its six years of operation, 160 IMGs have come through the program at hospitals in the Hunter New England local health area, using it as a pathway to general registration instead of the 16-stage clinical examination set by the Australian Medical Council.

“What we do, in my biased view, is much better than the AMC examination,” Professor Balakrishnan Nair, of Newcastle University’s Centre for Medical Professional Development, said.

He described the workplace-based assessment scheme as more rigorous but more supportive of participants.

The IMGs are subject to appraisal processes over a period of six months, with their fitness to practice measured through case-based discussions, mini clinical examination exercises and feedback from colleagues.

Doctors particularly valued getting constructive criticism from assessors after their appraisals, an important element in adult learning that was absent in the exam process, Professor Nair said.  They also tended to form stronger bonds with the medical fraternity as a result of the interaction.

“The other interesting thing is, more than 70% of the people who have been in the program stay in the system. They get to know the local system well.  They connect with the local clinicians,” Professor Nair said.

“Hunter New England has become the preferred employer for IMGs.”

Local hospitals were happy with the high retention rate after helping junior doctors progress to registration.  The opportunity cost of the workplace assessment program was calculated at $15,000 per participant, with IMGs each contributing $8000.

“It is a long-term investment. Our area health is quite happy because if you can assess them properly and you have a safer doctor, it’s not a huge amount of money.”

Between June 2010 and April 2015, 142 IMGs from 28 countries went through six months of workplace-based assessments run by the Newcastle university-based centre.

In total, they underwent 970 case-based discussions to test their clinical reasoning and 1741 mini clinical exercises, assessed by 99 senior clinicians who did not have contact with them as supervisors.

Each doctor was also judged on feedback from six colleagues including nursing, pharmacy and medical staff.

“The most important thing for doctors in 2016 is to work in a team and communicate with patients,” Professor Nair said. “So we said, the only way to test this is multi-source feedback. We ask, can they communicate, do they work in a team, do they ask for help when they need it?”

Normally, IMGs from non-English-speaking countries who wish to practise in Australia need to pass two
AMC requirements: a multiple-choice exam and English-proficiency test, followed by the 16-stage AMC clinical examination.

But candidates who pass the first exam are allowed to work temporarily in areas of need while waiting to take the clinical exam, opening the door to the workplace-based assessment experiment.

“We said, why don’t we check them out over a period of at least six months?

“ The rationale was, what’s important for the patient and the society is what the doctor does in real life, not what they know,” Professor Nair said.

The program was taking hold outside the Hunter region, with the Australasian College of Emergency Medicine adopting the model, and the college of physicians considering it, he said. Medical authorities in Canada, Singapore and the UK have also expressed interest in the results.

A detailed report on the program’s various components for measuring the fitness to practice of IMGs is published in the current issue of the Medical Journal of Australia.