ACRRM moves to review IMG exam

4 minute read

Less than a quarter of overseas-trained candidates for the rural college’s notorious PESCI interview are found suitable for practice.

ACRRM has called out a number of recommendations in a report looking at how to fast-track registration and immigration processes for overseas trained health professionals.

In the process, it has acknowledged the stringency and subjectivity of one of its own exams as a significant barrier to work for internationally trained doctors.

Released at the end of April, the interim report comes from a national cabinet-commissioned independent review of health practitioner regulatory settings led by senior public servant Robyn Kruk.

The review is developing short-term recommendations to address the current rural health workforce shortage with a consideration of internationally trained health workers and Australia’s attractiveness as a destination for skilled migrants.

As the report itself acknowledges, growing the domestic workforce is the preferred solution but will take decades, meaning that short-term priorities must focus on encouraging international doctors.

While the final report is slated for release in the coming months, the interim report pushes for urgent action on system reform.

Broad recommendations included removing duplication, allowing senior clinicians to more easily obtain permanent residency and aligning English language standards with the UK and New Zealand.

“Acknowledging the key role of Health Ministers under the National Registration and Accreditation Scheme and the urgency of the current situation, I recommend Health Ministers issue a direction to AHPRA and the National Boards to deliver a streamlined end-to-end registration system, expedite pathways for applicants from similar regulatory systems, and reaffirm the importance of patient safety as well as ensuring Australians can access timely and appropriate health services,” the report said.

The report makes 56 recommendations.

Responding to the report, ACRRM took issue with nine. It did not respond to every recommendation.

A special ire, though, was reserved for a proposal to transfer the duty of assessing whether two specialist training programs are equivalent to the Australian Medical College.

According to Ms Kruk and the reviewers, the specialist colleges – which currently perform this function – are often slow to complete comparability assessments, can charge variable fees and can be inconsistent.

“Contrary to the stated rationale for this recommendation, it is our expectation that the proposed transfer of the role of assessor to the AMC would be likely to increase the administrative burden, time frames and total cost for candidates to achieve fellowship,” ACRRM said.

“ACRRM has a well-trained pool of experienced and expert rural doctor SIMG assessors, pragmatic and highly efficient assessment pathways in terms of both time and cost for applicants.”

While interim report does not explicitly refer to the Pre-Employment Structured Clinical Interview (PESCI) in its recommendations, ACRRM did bring up the controversial international doctor test in its submission.

The PESCI, which is often the last hurdle standing between an overseas-trained doctor and registration, is not an exam in the traditional sense, but an interview designed to determine a doctor’s suitability to work in a specific role.

It is an exam in the sense that people either pass or don’t pass.

Data from the 2021-22 financial year, the most recent year for which data is available, revealed that only 84 out of the 345 would-be GPs who sat a PESCI with ACRRM were successful.

RACGP candidates fared slightly better – 66 out of 141 hopefuls went on to successfully gain registration.

ACRRM’s low success rate has long been a mystery, but the college is now prepared to open itself up for scrutiny.

“ACRRM contends that with over a decade of operation, it is timely to review the design of these processes particularly with the benefit of the experience and learnings of organisations such as our college,” it said.

Some of the issues that it has acknowledged include the fact that the high-stakes interview modality creates disproportionate distress for some applicants, which may not be representative of their capacity in an actual workplace scenario, as well as the fact that PESCIs are ultimately based on the interpretation of a standard, providing scope for subjectivity.

“This is of itself problematic as it lends scope for individual biases,” ACRRM said.

As alternatives, the college suggested workplace-based assessments, with which it conducted several extensive pilot trials about 10 years ago.

At the time, the AMC was against the initiative, citing potential conflicts of interest in an overseas-trained doctor’s employer also acting as an assessor.

ACRRM said this concern was “legitimate but manageable” and could be remedied by bringing in external assessors via online mechanisms.

The college also pushed for greater clarity on the accreditation standard with a view to making PESCIs more standardised across the board.

One of the potential solutions here, it said, would be using the Behaviourally Anchored Rating Scales  scoring approach, which is based on descriptors of behaviour rather than checklists.

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