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The Internship Test Match: Australia vs the United Kingdom

The hardest question for any assessment or standards setting agency in medicine is ‘when is a doctor safe and competent’.  With national standards for internship programs currently being developed, it is useful to discuss the differences between an Australian internship and the UK Foundation Program.

20 Feb 2012

The hardest question for any assessment or standards setting agency in medicine is ‘when is a doctor safe and competent’.  With national standards for internship programs currently being developed, it is useful to discuss the differences between an Australian internship and the UK Foundation Program.

An Australian internship has traditionally been built around core-rotations.  In all States and Territories, interns have been required to complete at least one term in each of a medicine, surgery, and emergency care setting. 

Historically, if an intern received satisfactory reports in these rotations then they were considered a ‘safe’ doctor and could gain general registration, as well as proceed to vocational training.

The UK now has a two-year prevocational program, the Foundation Program, to provide all graduates with a range of basic skills deemed necessary prior to starting vocational training.

The trainees, however, gain general registration in their second year of training.  This is because the legal requirements for new graduates are seen to be different from the educational requirements for vocational training in the UK.

These educational requirements are based on a set of competencies, soon to be called outcomes, that have been derived from various consultations and undergone refinement over the years.

Holding only provisional registration in the first year after graduation does not impede progression to vocational training from medical school in North America, nor does it affect the curriculum of the UK Foundation Program.  In these countries, the presence or absence of a prevocational training period has nothing to do with the requirements for general registration.

One of the major criticisms of the UK Foundation Program, according to the former Dean of Education at the Royal Australasian College of Surgeons Professor John Collins, was the over-assessment of trainees.  This is subsequently being reviewed in the UK. 

Checklists of procedures led to trainees overly focusing on getting items ticked off rather than learning on the job.  From a curriculum perspective, the aim of the Foundation Program was not to have each individual competency ticked off on a checklist, but to provide generic applied training such that the doctors are ready to proceed onto vocational training.

Importantly, no specialty college in the UK has prerequisites for entry as all junior doctors are considered fit for vocational training on completion of the Foundation Program.

In Australia, this would help alleviate the problem of junior doctors doing multiple service years in order to access competitive rotations that are designated by Colleges as pre-requisites.

Whether a two-year program is needed in Australia is still up for debate.  However, from both an educational and workforce perspective, the prevocational medical education system in Australia needs reform.

While the UK equivalent certainly has its flaws, it provides a useful template for comparison.  We should learn from their mistakes, reviews and experience.

Ross Roberts-Thomson is the newly appointed Deputy Chair of AMACDT.  He is currently undertaking a Churchill Fellowship looking at international models of prevocational training.  This article reflects his personal views, based on examination of postgraduate education systems in the US, UK and Canada.


Published: 20 Feb 2012