Policy on the Assessment of Specialist International Medical Graduates in New Zealand

SIMG508 V4

 

Document Review

Timeframe for review:                 every two (2) years, or earlier if required.

Document authorisation:            Council of Education

Document implementation:       Executive Director, Education/ General Manager, Education Assessment

Document maintenance:            SIMG Manager, SIMG Standards Lead

 

Revision History

 

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 New Zealand.  A policy specific to the assessment of SIMGs in Australia is also available (SIMG507).

In New Zealand, the specialist medical colleges act as a Vocational Education Advisory Body (VEAB) for the Medical Council of New Zealand (MCNZ) and provide advice and recommendations to the Council regarding an SIMG’s qualifications, training and experience, and their equivalence to a New Zealand-trained specialist in the relevant field of specialty practice for the purposes of obtaining Vocational Registration.

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.  Section C2 refers to specific regulations pertaining to SIMGs in New Zealand.  Regulation C2 is available on the College website.

In addition, the assessment process is the subject of a Memorandum of Understanding (MoU) executed between the College and the MCNZ and assessments conducted by ACEM in its capacity as a VEAB for the purposes of the provision of advice and recommendations to the MCNZ, are subject to the requirements of the MCNZ.

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), 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.

 

2. The Assessment Process

2.1 Applying for Assessment

In New Zealand, an SIMG, requesting specialist assessment, applies to the MCNZ.  If an SIMG’s application is deemed eligible for assessment, the MCNZ forwards the application to the College for advice regarding the SIMG’s qualifications, training and experience and whether these are ‘equivalent to’, ‘as satisfactory as’ or ‘neither equivalent to, nor as satisfactory as’ a New Zealand-trained specialist in emergency medicine for the purposes of obtaining Vocational Registration.

Pursuant to the processes of the MCNZ, where an SIMG is overseas the College will be requested to provide ‘preliminary advice’.  This advice is provided following a paper-based assessment conducted by the College in its capacity as a VEAB.  Where an SIMG is in New Zealand, the College will be requested to provide the MCNZ with ‘final advice’.  This advice is provided following interview assessment of the SIMG in its capacity as a VEAB.

2.2 Initial Assessment

A paper-based assessment, whether for the purposes of a request for preliminary advice or an initial assessment in relation to a request for interview, is conducted by a member of the SIMG Panel of Assessors, appointed by the SIMG Assessment Committee for this purpose, with the SIMG’s qualifications, training and experience assessed for equivalence to the standards of a newly elected FACEM.

2.3 Assessment at Interview

ACEM typically schedules monthly interview dates for SIMG applicants in Australia and New Zealand.  In New Zealand, assessment interviews are held at the College’s office in Wellington or via videoconference (such as via 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.

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 Specialist (FACEM) Training Program (i.e., paediatric experience and skills and critical care management, with particular reference to airway skills).

Pursuant to the MCNZ Policy on registration within a vocational scope of practice, and with reference to Good Medical Practice[1] and Cole’s Medical Practice in New Zealand[2], the areas explored in the interview reflect the domains of clinical expertise, communication, collaboration, management, scholarship and professionalism.  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 also be asked to respond to questions regarding the practice of emergency medicine in New Zealand 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 MoU between the College and the MCNZ, ACEM endeavours to complete the assessment process within three (3) months of the date of receipt of a complete application for assessment at interview.

Vocational Registration

Pursuant to the requirements of the MCNZ, the SIMG Assessment Committee will make one of the following decisions:

• That the applicant’s qualifications, training and experience are ‘equivalent to’ those of a doctor who is registered in the vocational scope of emergency medicine and holds the FACEM (MCNZ ‘supervision pathway’)
• That the applicant’s qualifications, training and experience are ‘as satisfactory as’ those of a doctor who is registered in the vocational scope of emergency medicine and holds the FACEM (MCNZ ‘assessment pathway’)
• That the applicant’s qualifications, training and experience are ‘neither equivalent to, nor as satisfactory as’ those of a doctor who is registered in the vocational scope of emergency medicine and holds the FACEM

This advice is then provided to the MCNZ, which will determine whether the SIMG is suitable for provisional registration within a vocational scope via the supervision pathway or the assessment pathway.  The applicant is advised by the MCNZ of the outcome of their assessment.

If the MCNZ determines that the SIMG is ‘neither equivalent to, nor as satisfactory as’ and they wish to attain Fellowship of ACEM, then they must enter the Specialist (FACEM) Training Program at the Provisional Training Stage, having met the necessary entry requirements (Reg C2.2.4).

Fellowship of ACEM

Separate to the advice that ACEM provides to the MCNZ on the equivalence of an applicant’s qualifications, training and experience to that of a FACEM, the SIMG Assessment Committee also determines the requirements the applicant needs to complete in order to become eligible to apply for election to Fellowship of the College.  These requirements may or may not be required for the applicant to attain registration in the vocational scope of emergency medicine.

 

3. Assessment of Equivalence

SIMGs are assessed for their equivalence to a New Zealand-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 for equivalence of a SIMG’s training program against the FACEM Training Program.  For the purposes of the provision of advice to the MCNZ, the assessment of equivalence is made having regard to Cole’s Medical Practice in New Zealand domains of clinical expertise, communication, collaboration, management, scholarship and professionalism.  For the purposes of determining a pathway to ACEM Fellowship, the Interview Panel will consider the extent to which the SIMG has or has not demonstrated the attainment of the global assessment articulated for each of the eight (8) domains of the ACEM Curriculum Framework.

While many of the ACEM 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 equivalence 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 Regulations 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 equivalent to a New Zealand-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 clinical 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 Regulation 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 a New Zealand-trained specialist in emergency medicine, the SIMG may be required to undertake a period of training/upskilling in paediatrics and/or to complete the ACEM 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 specific requirements of which are set out in Regulation 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 New Zealand who are dissatisfied with their assessment outcome as ultimately determined by the MCNZ may appeal this decision through the processes of the MCNZ.

In regard to ACEM’s requirements for Fellowship, SIMG applicants 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

5.1 Reassessment by the MCNZ

SIMGs should ensure they are familiar with the timeframe for which decisions of the MCNZ in relation to eligibility for provisional vocation scope registration are valid, as well as the circumstances and manner in which the MCNZ addresses unsatisfactory completion of the requirements set by the Council for the SIMG.

5.2 Reassessment by ACEM for the Purpose of ACEM Fellowship

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

• Applicants who are identified by the College as having qualifications ‘as satisfactory as’ those of a specialist in emergency medicine vocationally trained in New Zealand, where this is also the decision of the MCNZ, who commence the requirements of their pathway to Fellowship may not apply to the College for reassessment within four (4) calendar years of the date on which they were interviewed by the College (Regulation C2.2.2.4)
• Applicants in New Zealand who are removed from their pathway to Fellowship pursuant to College processes and who, at that time, hold or who are subsequently granted vocational registration in the scope of practice of emergency medicine by the MCNZ may not apply to the College for reassessment within 12 months of the date on which they were notified of removal from their pathway to Fellowship (Regulation C2.2.5.3)

Recognising the benefits of a specialist emergency medicine workforce that is supported by the College, SIMGs who are assessed by the College as having qualifications ‘as satisfactory as’ those of a specialist in emergency medicine vocationally training in New Zealand and who have not completed the requirements for eligibility for election to Fellowship identified by ACEM, yet have, by virtue of a decision of the MCNZ, obtained vocational registration through a different pathway, are able to apply to the College for reassessment for the purpose of attaining FACEM (Regulation C2.2.3).

Similarly, applicants who are assessed by the College as ‘neither equivalent to, nor as satisfactory as’ and who are subsequently granted vocational registration in the scope of practice of emergency medicine by the MCNZ, are able to apply to the College for reassessment in order to determine the equivalence of their training, qualifications and experience to that of a Fellow of the College and an associated pathway to ACEM Fellowship (Regulation C2.2.4).

 

6. Associated Documents

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