Entry requirements for vocational training - 2014

17 Jun 2014

Australia has a responsibility to train medical graduates efficiently and effectively to produce high quality vocationally trained medical practitioners capable of independent and safe practice. Fundamental to the quality of medical education in Australia are the medical colleges who are responsible for the rigorous training standards and arrangements that set the benchmark for specialist practice. The key to assuring a highly qualified and well-trained medical workforce is the selection of the best possible candidates for specialty training.i

The process of trainee selection is complex and a lack of conclusive evidence makes it difficult to define best practice in this area. In Australia, trainee selection processes are performed by both medical colleges and health services with the input of each stakeholder varying between different specialties. Further research is required to establish which trainee selection methods provide sufficient predictive validity and reliability for selection.ii

Ultimately trainee selection processes must be able to differentiate amongst candidates of similar ability with the twin aims of selecting the best possible candidates for specialty training and the best possible candidates to become a future specialist. They must also provide a common, unbiased means of assessing candidates of diverse economic, personal, cultural and academic backgrounds and must have the confidence of the prevocational and vocational trainees, the professional colleges, the training providers and the public.iii 

This position statement focusses specifically on entry requirements for vocational training as defined by the learned colleges. Entry requirements for vocational training commonly take into account a range of academic and vocational considerations, and in some instances, clinical and research pre-requisites. Entry requirements to vocational training should facilitate the merit-based selection of the appropriate number of trainees into each vocational training pathway.

This position statement sets out the principles the AMA considers should underpin entry requirements for vocational training and is written with reference to the Australian Medical Council’s Standards for Assessment and Accreditation of Specialist Medical Education Programs (2010) and the Commonwealth Medical Training Review Panel report on Trainee Selection in Australian Medical Colleges (1998).

1. Background

1.1. All medical graduates require postgraduate vocational training prior to entering independent practice. Essentially, the purpose of vocational training is to provide the training, education and supervision required to equip a ‘pluripotential’ prevocational trainee with the skills to meet the standards to be awarded Fellowship in a specialty college. The end point of such training is the achievement of Fellowship of one of the medical colleges.

1.2. The AMA supports the role of the Colleges in setting training standards, accrediting training sites, and training, assessing and examining candidates against College standards within the broader accreditation framework established by the Australian Medical Council (AMC). 

1.3. The AMA supports the role of the AMC in assessing and accrediting specialist medical education and training, and professional development programs run by the Colleges. The AMC Standards for Assessment and Accreditation of Specialist Medical Education Programs provide an excellent basis to assess college processes more broadly, and selection processes more specifically, and to make recommendations for improvement as appropriate. 

1.4. Sufficient numbers of high quality vocational training places must be available for medical graduates to ensure the community has access to a highly qualified and well-trained medical workforce.  The number of medical graduates entering specific vocational training programs should be free from political interference and determined by community need, national health workforce planning data and the ability of the system to deliver high quality training

1.5. Ultimately, appropriate vocational training capacity will minimise the development of an unnecessary and protracted prevocational period employment for doctors in training waiting for entry to vocational training programs. 

1.6. However, the rise in medical graduates numbers, insufficient prevocational and vocational training capacity and subsequent competition for training places in specialty training programs, is creating an entry ‘bottleneck’ into prevocational streaming rotations and vocational training programs. This adds to the imperative to ensure that entry requirements for selection into vocational training programs are clear, relevant and candid.

1.7. Vocational training programs have both implicit and explicit entry requirements.  Explicit entry requirements are those that are acknowledged by a specialty college and form part of the application process.  Implicit entry requirements are not acknowledged by the specialty college but in reality are required for an applicant to have a reasonable chance of success in their application.

2. The principles of entry requirements for vocational training

2.1. The AMA believes that prevocational training should give doctors the requisite experience to commence vocational training. The AMA supports published explicit pre-requisites for vocational training programs where they are achievable by prevocational trainees during routine prevocational training.

2.2. The AMA does not support pre-requisites that are unnecessarily onerous and/or extraneous to beginning practice as a vocational trainee, particularly those that are hidden or implicit, or are of high cost but not required by trainees for selection. 

2.3. It is essential that entry requirements for vocational training are transparent, supported by the best available evidence base, accessible from all training sites and follow the following principles:

(a) Entry requirements should:

  • be merit-based with the aim of selecting the best possible candidates for training in a particular specialty;
  • be equitable, valid and relevant;
  • be objective, unambiguous, transparent and achievable; and
  • be made publicly available to trainees within a sufficient timeframe prior to the selection process;

(b) Any changes to entry requirements, and the rationale and implications for change, should be made publicly available within a sufficient timeframe to allow potential applicants the opportunity to prepare their applications;
(c) Any weighting system/and or points attached to specific entry requirements should be documented, published, clear and quantifiable to the greatest possible extent; 
(d) The criteria and process for seeking exemption from such requirements must be clearly outlined to trainees; 
(e) Selection processes for a vocational training program should be efficient;
(f) Costs incurred by candidates as part of the selection process, including through any prerequisite courses, should be reasonable and justifiable;
(g) Prospective trainees in all jurisdictions should have access to the same opportunities and resources where practicable to help them prepare an application for a training program;
(h) Processes should not disadvantage trainees that have commenced additional studies, work or preparations as part of preparing for vocational training;
(i) Honest and frank feedback should be available to unsuccessful candidates;
(j) Provision should be made for a fair, visible and accessible  appeals process of decisions in relation to selection;
(k) There should be sufficient flexibility for trainees to move between training pathways by adequate recognition of prior learning and competencies, including relevant training administered by other Colleges; and 
(l) Where interviews are conducted as part of the selection process, these should be structured, objective and reflect best practice with the aim of determining and confirming the suitability of an applicant for vocational training.