1. Introduction

The specialist medical colleges have an integral role in the assessment of Specialist International Medical Graduates (SIMGs) in both Australia and New Zealand through the determination of the pathway by which individual SIMGs may gain recognition by the relevant authority for the purposes of registration as a specialist in the relevant specialty field.  There are, however, subtle differences between the roles of the colleges in the two jurisdictions and, for this reason, this policy is specific to the assessment of SIMGs in Australia.  A policy specific to the assessment of SIMGs in New Zealand is also available (SIMG508).

Under the National Law, the Medical Board of Australia (MBA) has delegated the assessment of SIMGs to the specialist medical colleges accredited by the Australian Medical Council (AMC).  The colleges assess SIMGs for comparability to an Australian-trained specialist in the relevant field of specialty practice and applicants must meet the requirements set by the College to be eligible for Fellowship of the relevant specialist college (e.g. FACEM) in order to obtain specialist registration with the MBA / Australian Health Practitioner Regulation Agency (AHPRA) [1].

Pursuant to provisions of the constitution of the Australasian College for Emergency Medicine (ACEM; ‘the College’), the Board has approved regulations relating to various areas of College activity.  Section C governs the assessment of SIMGs and the requirements of subsequent pathways to Fellowship; these are available on the College website.

This policy provides additional guidance to SIMGs, and those involved in their assessment and/or supervision, whether as a member of the SIMG Assessment Panel (Interview Panel), the SIMG Assessment Committee, Council of Education (COE) or other capacity.  This policy is, however, subordinate to the regulations and to the extent that there is any inconsistency, the regulations prevail.

All processes conducted in the assessment of SIMGs at ACEM are in compliance with the provisions of the MBA Standards: specialist medical college assessment of specialist international medical graduates (January 2021).

2. The Assessment Process

2.1 Applying for Assessment

In Australia, for the purposes of becoming eligible for FACEM and thus specialist registration with the MBA/AHPRA, an SIMG first applies to the AMC for Primary Source Verification (PSV) of their medical education and specialist qualification(s), and then applies directly to ACEM using the prescribed form for assessment of their comparability to an Australian-trained specialist in emergency medicine.

All relevant information specified on the application form, together with payment of the assessment fee must be submitted at the time of application.  Applications will not be progressed until such time as all necessary documentation required by the College, the assessment fee and proof of application for PSV, utilising the processes of the AMC, have been received.  An application for assessment will lapse if payment and/or any required documentation or other information remain outstanding after the timeframe specified by the College, currently six (6) months.

Upon receiving a complete application, the College (SIMG unit) commences the interim assessment process for comparability.  SIMGs will be assessed via a paper-based assessment (Initial Assessment) to evaluate whether they have achieved the minimum requirements for interview.  This process includes providing the SIMG with a summary of the preliminary review (SPR) of their application before any decision is made.  SIMGs deemed to be eligible for interview will be invited for Assessment at Interview.   

2.2 Initial Assessment/ Summary of Preliminary Review

The initial assessment and Summary of Preliminary Review processes are conducted by a member of the SIMG Assessment Panel, appointed by the SIMG Assessment Committee for this purpose, with the application assessed against the requirements of FACEM for comparability to an Australian-trained specialist in emergency medicine.   The SPR which maps the information provided by the SIMG applicant against the College’s assessment criteria, is provided to the applicant by email before an initial assessment decision is made.  The applicant is allowed 21 days to provide clarification or submit additional information/evidence if they believe there are errors of fact, perceived gaps or omissions in the information assessed.  

In order to be considered for interview, Regulation C1.2.7 states that it is generally expected that the SIMG will have completed a specialist training program in emergency medicine that:

• was a structured post-graduate course of at least three (3) years duration, with published standards that are comparable to that of the FACEM Training Program;
• contained a documented and systematic in-training assessment system incorporating regular, on-going formative and summative performance-based assessments, examinations and other assessments comparable to those undertaken by FACEM trainees; and
• was accredited against published standards by an external body and was subjected to assessment for reaccreditation at regular intervals.

The outcome of the initial assessment will be either:

• ‘Not Comparable’ to an Australian-trained Specialist in Emergency Medicine; or
• ‘eligible for interview for assessment of comparability to an Australian-trained Specialist in Emergency Medicine’.

Applicants assessed as ‘Not Comparable’ will have this decision reported by the College to the MBA as the ‘assessment outcome’.

2.3 Assessment at Interview

ACEM typically schedules monthly interview dates for SIMG applicants in Australia and also in New Zealand.  In Australia, assessment interviews are held at the College’s offices in Melbourne or via videoconference (such as Zoom), whichever is deemed most appropriate by the College at the time.  Interview dates are generally approved by COE in late November of the preceding year and are published on the ACEM website once this has occurred.  Applicants will be advised of the first available interview date at the time of notification that they are eligible for interview.  If an SIMG fails to accept an invitation to attend an interview within six (6) months of the date of notification of the outcome of the initial assessment, their application for assessment will lapse.  If the SIMG subsequently wishes to be assessed, they are required to submit a new application, with all associated fees payable (Regulation C1.2.9).

The interview panel ordinarily comprises three (3) FACEM members of the SIMG Assessment Panel and one (1) Community Member, all of whom have been appointed to the Panel by the SIMG Assessment Committee.   Members of College staff may also attend the interview, and on occasion an observer may attend in an official capacity. 

The interview provides an SIMG with an opportunity to elaborate upon the information provided in their application and involves a detailed discussion of the requirements of their primary medical training, basic and advanced stages of their specialist training, subsequent specialist practice and participation in ongoing continuing professional development.  Specific areas include those that are central requirements of the FACEM Training Program (i.e., paediatric experience and skills and critical care management, with particular reference to airway skills).

Questions that reflect the eight (8) domains of the ACEM Curriculum Framework will also be discussed in the interview.  As such, SIMGs will also be asked about their experience in conducting education in emergency medicine, at both undergraduate and postgraduate levels.  Additionally, the interview will explore an SIMG’s historical and continuing involvement in research and any resulting publications.

SIMGs should ensure they provide the College with copies of relevant research papers and can expect to be asked to discuss some of these in detail (e.g. their role in the research and study design, methodology employed, statistical analysis, publication and/or presentation of findings).  In the context of an SIMG’s experience and role(s) in emergency medicine administration as evidenced in the curriculum vitae, the issues raised by this integral component of FACEM specialist practice will also be discussed during the interview.  In addition, SIMGs will be asked to respond to questions regarding the practice of emergency medicine in Australia with a focus on culturally safe and respectful care.

Following the interview, the Interview Panel will determine a recommended outcome and submit a report, for consideration and approval by the SIMG Assessment Committee.

2.4 Assessment Outcome

Pursuant to the requirements of the MBA and in accordance with ACEM Regulation C1.4.1, the SIMG Assessment Committee will make one of the following decisions:

• That the applicant’s training and experience is such that they are ‘Substantially Comparable’ to an Australian-trained Specialist in Emergency Medicine
• That the applicant’s training and experience, while not such that they are considered ‘Substantially Comparable’ to an Australian-trained specialist in emergency medicine, is such that they are considered to be ‘Partially Comparable’ to an Australian-trained Specialist in Emergency Medicine
• That the applicant’s training and experience is such that they are considered neither partially nor substantially comparable (i.e. ‘Not Comparable’) to an Australian-trained specialist in emergency medicine

Where the recommendation is that the SIMG is ‘Substantially Comparable’ to an Australian-trained specialist in emergency medicine or that they are ‘Partially Comparable’ to an Australian-trained specialist in emergency medicine, the Committee’s decision will stipulate the specific requirements that the SIMG needs to complete in order to become eligible to apply for election to Fellowship and thus to attain specialist registration (refer Regulation C1.5.1 and C1.6.1).  The College will notify the applicant of this assessment and report this to the MBA.

SIMGs assessed as ‘Not Comparable’ to an Australian-trained specialist in emergency medicine and who wish to attain Fellowship will need to enter the FACEM Training Program at the Provisional Training Stage, having met the necessary entry requirements.  The College will notify the applicant of this assessment and report this to the MBA.

ACEM endeavours to complete this initial assessment process within three (3) months of the date of receipt of a complete application for assessment.

3. Assessment of Comparability

SIMGs are assessed for their comparability to an Australian-trained specialist in emergency medicine, with the decision made having regard to that which is evidenced in the SIMG’s application and demonstrated at interview, regarding the applicant’s Qualifications, Training and Experience (QTE).  The assessment is of the individual SIMG, their training and subsequent experience, and it is more than an assessment of equivalence of a SIMG’s training program against the FACEM Training Program.  The assessment of comparability is made having regard to the eight (8) domains of the ACEM Curriculum Framework and the topics within each domain, with the Interview Panel considering whether the SIMG has or has not demonstrated the attainment of the global assessment articulated for each domain.

While many of the learning outcomes, including but not limited to specified investigations and procedures, are assessed through mechanisms such as logbooks, Workplace Based Assessments (WBAs), and written and oral examinations within the FACEM Training Program, others are assessed through a specific requirement; examples include the critical care, paediatric and research requirements.  However, the assessment of comparability of an SIMG considers both the applicant’s training and their subsequent experience.  As such, if the specialist training program completed did not, for example, have a compulsory component of paediatric emergency medicine, however the SIMG can demonstrate that, through subsequent specialist experience, they have experience comparable with that of a newly elevated FACEM, this will be relevant to the decision regarding the relevant learning outcome and the College’s expectations of a newly qualified FACEM.

3.1 Specific Requirements of the FACEM Training Program

Critical Care Requirement

Trainees within the FACEM Training Program are required to undertake six (6) FTE months of satisfactory critical care training; critical care training may only be undertaken in the disciplines of anaesthetics or intensive care medicine (refer Regulation B2.3.4, G2.3.5).  As such, the Interview Panel will consider whether the applicant, through their training, subsequent experience or a combination thereof, can be considered comparable to an Australian-trained specialist in emergency medicine in relation to critical care skills and knowledge.  Where they are not, either wholly or in part, the assessment outcome may require the SIMG to undertake a period of training/upskilling in this specific area.

Paediatric Requirement

The FACEM Training Program contains a minimum requirement in relation to paediatric emergency medicine.  This requirement may be met through satisfactory completion of:

• a six (6) FTE month placement in a dedicated paediatric emergency department accredited by ACEM for the purposes of training in paediatric emergency medicine; or
• the ACEM paediatric logbook with associated WBAs; or
• upon application and approval by COE/approved delegate, a combination of the placement and logbook.

Specific requirements of the paediatric requirement are set out in Regulations B2.3.7 and G7 (applicable from 2022).  Where it is determined that the applicant’s paediatric knowledge, skills and competency is not, either wholly or in part, comparable to that of an Australian-trained specialist in emergency medicine, the SIMG may be required to undertake a period of training/upskilling in paediatrics and/or to complete specific paediatric requirements in order to become eligible for election to Fellowship.

Research Requirement

The primary mechanism by which several learning outcomes of the Scholarship and Teaching domain of the ACEM Curriculum Framework are assessed is through the compulsory research requirement; the specifics of which are set out in Regulations B4 and G4 and the Guidelines for Assessing SIMG Research Experience.  The relevant topics within this domain are:

• Finding and critically appraising the evidence
• Applying academic knowledge to emergency medicine practice
• Basic elements of creating research: Academic writing and research participation

As such, while it is not necessary for the applicant to have completed a research project in the course of their specialist training that meets the research project requirements of the FACEM Training Program, the extent to which the applicant demonstrates attainment of the learning outcomes associated with the above listed topics, will be assessed.

Where it is determined that the applicant has not, either wholly or in part, through their training and experience demonstrated that they have attained the learning outcomes of the above listed topics, they may be required to satisfactorily complete the research requirement of the FACEM Training Program in order to become eligible for election to Fellowship.

4. Appeals

SIMG applicants in Australia may seek reconsideration, review and/or appeal of their assessment decision and outcome through the provisions of the ACEM Reconsideration, Review and Appeals Policy.

5. Reassessment

The timeframes within which an applicant is able to submit an application for reassessment are prescribed in the relevant College regulations:

• The assessment decision of comparability is valid for a period of 12 months from the date of notification of the decision and an applicant cannot apply for reassessment during this period (Regulation C1.4.3)
• SIMGs assessed as ‘Substantially Comparable’ to an Australian-trained specialist in emergency medicine who commence the requirements of their pathway to Fellowship for the purposes of becoming eligible for election to Fellowship may not apply for reassessment within two (2) calendar years of the date on which they commence supervised practice in a position approved by the College (Regulation C1.5.3)
• SIMGs assessed as ‘Partially Comparable’ to an Australian-trained specialist in emergency medicine who commence the requirements of their pathway to Fellowship for the purposes of becoming eligible for election to Fellowship may not apply for reassessment within four (4) calendar years of the date on which they commence supervised practice in a position approved by the College (Regulation C1.6.3)

6.  Associated Documents

• ACEM Curriculum Framework
• ACEM Regulation B - ACEM Specialist Training Program
• ACEM Regulation C - Assessment of Specialist International Medical Graduates
• ACEM Regulation G – FACEM Training Program 2022
• Exceptional Circumstances and Special Consideration Policy (TA79)
• Reconsideration, Review and Appeals Policy (COR355)