IMG Guide V

Information for International Medical Graduate

Applicants

REVISED March 2017

Royal Australasian College of Surgeons

College of Surgeons’ Gardens
250-290 Spring Street
Melbourne Victoria 3002
Australia

Phone: +61 3 9249 1242

Fax: +61 3 9249 1219
Email: [email protected]
Website: www.surgeons.org

Specialist assessment guide for applicants 1

CONTENTS

What is specialist assessment? 3

What is area of need assessment? 3
Who is eligible to apply for assessment? 4
Who will assist with your application? 4
The specialist assessment process 5
Assessment fees 8
Applying for specialist assessment 9
Interim assessment of comparability 9
Document based assessments 9
IMG interviews 10
Definitions of comparability 12
Definition of suitability for an area of need position 13
Definition of defined scope of practice 13
Ongoing assessment 14
Finding Hospital Employment 14
IMG Orientation Program 15
Level 4 Supervision 15
Level 3 Supervision 16
Professional Development Activities 17
Maintenance of Professional Standards 17
Fellowship Exam 18
Final Assessment 18
Roles and Responsibilities of the Applicant 18
Timeframes 19
Validity of the Assessment 19
Duty to Disclose all Relevant Information 19
Communication with the RACS and Clinical Assessors 19
Contacts in Australia 20
Contacts in New Zealand 20
Visa requirements 20
Complaints and Appeals 20
Guidelines and Forms 21
Policies 21
Definitions 22

Specialist assessment guide for applicants 2

WHAT IS SPECIALIST ASSESSMENT?
Specialist assessment is the process by which International Medical Graduates (IMGs) with a
specialist surgical qualification gain registration to practise as specialists in Australia. Before you can
apply for specialist registration with the Medical Board of Australia (MBA), the Royal Australasian
College of Surgeons (RACS) will assess whether your training, assessment, experience, recent
practice and continuing professional development are comparable to an Australian and New Zealand
trained surgeon.

The RACS assesses overseas-trained specialists in the following specialty areas:

Specialties

• Cardiothoracic Surgery
• General Surgery
• Neurosurgery
• Orthopaedic Surgery
• Otolaryngology Head & Neck Surgery
• Paediatric Surgery
• Plastic & Reconstructive Surgery
• Urology
• Vascular Surgery

Specialist assessment has several stages:

• application
• Interim assessment (document-based assessment and/or interview)
• ongoing assessment in the workplace (peer review or clinical assessment)
• final assessment decision

IMGs who have commenced a specialist pathway can take up to four years to complete.

There are fees at each stage.

WHAT IS AREA OF NEED ASSESSMENT?

Area of Need (AoN) assessment is for IMGs with a specialist surgical qualification who have been
offered a position in Australia in a designated ‘AoN’. An AoN is determined by the relevant state or
territory health authority. The RACS is not responsible for determining AoN positions, or assisting
applicants to find an AoN position. Your employer will be able to advise you if the position you have
been offered is classified an AoN.

If you have secured an AoN position, you will need to be assessed by the RACS before being eligible to
practise in the position. An IMG will be deemed to be suitable for an AoN position if:
 There is evidence of recency of surgical practice in the relevant scope of practice required for
the AoN post; and
 the specialist assessment results in a recommended pathway to fellowship by assessment or
examination under Level 4 supervision; andor
 assessed with a subspecialty scope of practice specific to the AoN position; or
 12 months of Level 3 supervision has been completed in a non-AoN position and the relevant
Specialty Board considers the post suitable for completion of the remaining periods of
assessment; or

Specialist assessment guide for applicants 3

  3 months of Level 3 supervision has been completed in a major teaching or tertiary hospital of
the relevant specialty and the specialty board considers the post suitable for completion of
the remaining periods of assessment; and
 The AoN position has been deemed suitable by RACS.

The RACS requires all IMGs seeking area of need assessment to apply at the same time for specialist
assessment in the relevant speciality.

WHO IS ELIGIBLE TO APPLY FOR ASSESSMENT?

To be eligible to apply for specialist assessment with the RACS, an applicant must:
• have completed specialist training overseas in one of the specialties that is assessed by the
RACS (listed above); and
• be recognised as a specialist surgeon in their country of training; and
• apply directly to Educational Commission for Foreign Medical Graduate's (ECFMG)
Electronic Portfolio of International Credentials (EPIC) for verification of both primary and
specialist qualification(s); and
• complete an Australian Medical Council (AMC) online application to establish an AMC
portfolio.

To be eligible to apply for area of need assessment, an applicant must:

• have been offered a designated AoN position; and
• meet the criteria for specialist assessment; and
• also apply for specialist assessment.

WHO WILL ASSIST WITH YOUR APPLICATION?

The IMG Department at RACS manages all specialist assessment applications. When you have
submitted your application, the IMG Department will contact you. The IMG Department will guide you
through the assessment process.

Email address
[email protected]

Contact number
+61 3 9249 1112

Postal address
IMG Assessment Department
Royal Australasian College of Surgeons
250-290 Spring Street
East Melbourne, Victoria, 3002

Please read this guide before making a general enquiry about specialist assessment

Specialist assessment guide for applicants 4

THE SPECIALIST ASSESSMENT PROCESS
Specialist assessment application

Before applying to RACS for specialist assessment, you must apply directly
to the Educational Commission for Foreign Medical Graduate's (ECFMG)
Electronic Portfolio of International Credentials (EPIC)
Apply for Primary
http://www.ecfmgepic.org/physicians.html for verification of both primary and
Source Verification
specialist qualification(s).
via the ECFMG
Further information on primary source verification is available at
http://www.amc.org.au/assessment/psv

After applying to ECFMG for primary source verification of your

Apply for an AMC
qualifications, complete an Australian Medical Council (AMC) online
Portfolio
application to establish an AMC portfolio at https://portal.amc.org.au/

After applying for primary source verification of your qualifications via the
ECFMG and completion of AMC portfolio via the AMC, you can apply directly
to RACS https://www.surgeons.org/becoming-a-surgeon/international-
Apply online for RACS
medical-graduates/img-application-form/ for specialist assessment.
Specialist Assessment
If you have been offered an area of need position, submit your area of need
assessment application with your specialist assessment application.

Specialist assessment guide for applicants 5

Assessment of comparability

STAGE 1 The first phase of the RACS specialist assessment process consists of a
document-based assessment.
Document-based
assessment The document-based assessment involves assessment by the RACS Clinical
Director, IMG Assessments and Support, and Specialty Chair and/or IMG
Representative of the relevant Specialty Board.

The recommendations which may arise from the document-based assessment

include:

 You are required to attend interview within 6 months to finalise your

assessment or
 You are not comparable and are required to undertake further training.
You will be referred to the AMC to obtain general registration.

If you are deemed not comparable following a document based assessment, you
will not be required to attend an interview. This is referred to as a ‘Final
Recommendation’. The interview component of the assessment fee will be
refunded.

STAGE 2 The second phase of the RACS specialist assessment process consists of a face-
to-face interview assessment.
Interview and
Interim The Assessment Interview Panel will make a recommendation concerning your
Recommendation comparability with an Australian or New Zealand trained surgeon.

The classifications which arise from the documentary assessment and interview
are as follows:

 You are not comparable to an Australian or New Zealand trained surgeon

 You are partially comparable to an Australian or New Zealand trained
surgeon
 You are substantially comparable to an Australian or New Zealand trained
surgeon

The RACS determines your comparability to an Australian and New

Zealand trained surgeon. This Interim assessment decision will specify the
Interim assessment requirements you must complete to gain specialist recognition in Australia
decision sets and Fellowship of RACS.
requirements for
specialist recognition If you are found not comparable to an Australian and New Zealand
and Fellowship of trained surgeon, the specialist assessment process will end at this
RACS stage.

Further information on the Interim assessment of comparability

Specialist assessment guide for applicants 6

Ongoing assessment

If the Interim assessment decision is that you are substantially or

partially comparable to an Australian and New Zealand trained
surgeon, you can commence your requirements for specialist
recognition and Fellowship of RACS.
Your requirements may include one or more of the following:
• RACS Fellowship examination
Complete
requirements for • work-based assessment tasks
specialist recognition • top up training and/or specified skills courses
• clinical practice under Level 3 Supervision or Level 4 Supervision
• a practice visit
• IMG Orientation program
• Operating with Respect program
Further information on Ongoing assessment

Final assessment

The RACS assesses whether you have satisfactorily completed

your requirements for specialist recognition and Fellowship of
RACS.

If you have satisfactorily completed your requirements, the RACS will notify
the Australian Health Practitioner Regulation Agency and recommend you
Final assessment for specialist recognition. The RACS will also recommend you for
decision Fellowship of the appropriate surgical specialty of the RACS. The RACS
IMG Department will contact you to advise how to apply for Fellowship.

Further information on Final assessment

If you do not complete the requirements within the allotted time, you may
fail to achieve specialist recognition.

Contact AHPRA to apply for specialist registration

https://www.ahpra.gov.au/

Apply for Fellowship of the RACS

https://www.surgeons.org/my-page/my-menu/application-to-fellowship/

Specialist assessment guide for applicants 7

ASSESSMENT FEES

There are fees at each stage of the specialist assessment and area of need assessment processes. You
should be aware of the required fees before submitting an application to RACS. At each stage, your
assessment will not advance until you pay the required fee.

You are advised to review the RACS schedule of fees on the RACS website www.surgeons.org
for up to date I M G assessment fees.

RACS Application for Specialist and/or Area of Need Assessment Fee

You must pay this fee when you submit your RACS application for specialist assessment online.

RACS Clinical Assessment Fee

You must pay this fee upon commencement of your clinical assessment for monitoring and assessment
of your surgical practice. This fee is payable annually until completion of your clinical assessment
period.

RACS Administration Fee

You must pay this fee once you have completed your period of clinical assessment and remain on a
pathway to Fellowship

Area of Need Assessment Fee

You must pay this fee if you submit a subsequent area of need application.

Further information on IMG fees is available on the International Medical Graduate Fees in Australia policy
available on the RACS website https://www.surgeons.org/policies-publications/policies/international-
medical-graduates/

Specialist assessment guide for applicants 8

APPLYING FOR SPECIALIST ASSESSMENT
 Review the information in this guide before submitting a specialist assessment application.
 Apply for primary source verification of your qualifications to the ECFMG and to
the AMC to establish AMC portfolio before applying to the RACS.

 Review checklist of the documentation to be submitted with online application for

Specialist and/or Area of Need assessment. The checklist if available at on the
RACS website https://www.surgeons.org/becoming-a-surgeon/international-
medical-graduates/contact,-guidelines-and-resources/

The IMG Department will advise you of any missing documents upon receipt of your
online specialist assessment application. The RACS may also request further documents
if required.

You will be given one month to submit the required documents or your application will
expire.

INTERIM ASSESSMENT OF COMPARABILITY

Interim assessment of comparability to an Australian and New Zealand surgeon
determines the requirements you must complete to be recognised as a specialist.
To determine comparability, the RACS will:
• review the documentation you have provided in your application;
• conduct an interview if necessary
• make any other enquiries it considers necessary.

An Interim assessment is not a conclusive decision that you are competent to practise as
a specialist in Australia. It enables you to progress to ongoing assessment to complete
the requirements stipulated by the RACS.

DOCUMENT BASED ASSESSMENT

Once your application is received via our online application system, the RACS will undertake a
review of the documentation you have submitted to ensure your application is complete. If the
documentation appears to be incomplete, the RACS will contact you directly by email. The
RACS specialist assessment will be activated once all the requisite documentation has been
received.

RACS determines a pathway to fellowship based on a comparison to the education and training
of an Australian and New Zealand trained surgeon. The factors considered are:
• Recency of practice
• Education and training program completed
• Exit examination completed;
• Quantity, depth and scope of practice since completion of training
The first phase of the RACS specialist assessment process consists of a document-based
assessment.

The document-based assessment is an assessment of all the documentation provided by you

with your application.

It is important that you submit all the documentation relating to the items listed in the online
application form, and any additional information that you think may be relevant to your
application. A recommendation will be made on the basis of documentation received and/or
interview.

The document-based assessment will involve assessments by the RACS Clinical Director for
IMG Assessments and Support, and Specialty Chair or nominee of the relevant Specialty
Board.

The recommendations which may arise from the document-based assessment include:

• You are required to attend interview within 6 months to finalise your assessment.
• You are Not Comparable and are required to undertake further training.

Note: If you are deemed Not Comparable following a document based assessment, you
will not be required to attend an interview. This is referred to as a ‘Final
Recommendation’. The interview component of the assessment fee will be refunded.

Note: An assessment as Not Comparable does not reflect on your capabilities as a practitioner.
The assessment of comparability is based upon a detailed comparison of training programs,
curricula, exit examinations and surgical experience including recent practice.

RACS INTERVIEWS

If you are required to attend a face-to-face interview to finalise your assessment, this constitutes
the second phase of the assessment process.

The purpose of the interview is to explore specific aspects of your surgical practice, for example,
your professional communication skills, your ability to evaluate your surgical practice and your
professional ethics. You will have an opportunity during the interview to demonstrate your views
and knowledge on these issues by responding to a series of standardised questions, and one or
two brief written hypothetical ‘scenarios’. In addition, the interview provides the Assessment
Interview Panel with an opportunity to further explore and clarify any aspect of your surgical
training and education, and your professional experience and practice, as outlined in the
documentation you have provided. The interview also provides you with an opportunity to ask
any questions.

The Assessment Interview Panel will be seeking to assess how well prepared you are to
practise as a specialist in Australia. The interview process will take approximately one hour and
15 minutes, which involves a pre-briefing amongst panel members, the interview with the
applicant and post-interview deliberations amongst panel members.

The members of the Assessment Interview Panel comprise:

• The Specialty Chair and/or IMG Representative of the relevant Specialty Board
• A representative from the Board of Surgical Education Training (BSET)
• A jurisdictional or community representative

Royal Australasian College of Surgeons 10

The Assessment Interview Panel will make an Interim Recommendation concerning your
comparability with an Australian or New Zealand trained surgeon. The classifications which
arise from the documentary assessment and interview are as follows:

 You are not comparable to an Australian or New Zealand trained surgeon

 You are partially comparable to an Australian or New Zealand trained surgeon
 You are substantially comparable to an Australian or New Zealand trained surgeon

If you are deemed Not Comparable, you are required to undertake further training and therefore
will need to liaise with the AMC to obtain general registration. Once you have obtained general
registration and permanent residency, you will be eligible to apply to the RACS Surgical
Education and Training Program (SET). If you are successful in obtaining a place on the SET
program, the relevant Specialty Board may shorten the duration of training required according to
your progress in accordance with the RACS Recognition of Prior Learning policy.

If you are deemed Partially Comparable, you will be required to undertake a period of up twenty-
four months of assessment of clinical practice, completion of upskilling/courses and sit and pass
the Fellowship Examination as recommended in your Interim Recommendation.

If you are deemed Substantially Comparable, you will be required to undertake a period of up to
twelve months of assessment of clinical practice and completion of upskilling/ courses as
recommended in your Interim Recommendation. You will not be required to sit the Fellowship
Examination.

How to prepare for your interview

The interviewers will prepare questions based on the information you have provided in
your application. Questions may cover the following areas:
• basic or core training, advanced or specialist training
• specialist practice
• participation in continuing professional development
• your quality assurance practices
• attainment of higher qualifications
• contributions to the field of surgery
Interviewers will assess your competency taking into consideration your technical clinical skills
and the non-technical professional attributes described in the RACS Competencies and other
professionalism and performance guidelines available on the RACS website
http://www.surgeons.org/becoming-a-surgeon/surgical-education-training/competencies/
It is useful for you to have a good understanding of the RACS Surgical Education Training
program to demonstrate how your training, assessment and experience compare. You
should familiarize yourself with the RACS comparable specialist surgical training and exit
examination policy applicable to your specialty.
https://www.surgeons.org/policies-publications/policies/international-medical-graduates/

Important considerations
• There will be a waiting period for your interview. The RACS schedules interviews 6
times a year, February, April, June, August, October and December. The IMG
Department will contact you to advise you of the next available interview date.

Royal Australasian College of Surgeons 11

 • RACS interviews are usually held at the RACS Head Office in Melbourne, Victoria.

Definitions of comparability
The RACS assessment determines your comparability to an Australian and New Zealand
trained surgeon, using the definitions of comparability laid down by the Medical Board of
Australia. We have adapted these definitions only to make them specific to the RACS.

Substantially Comparable
An IMG will be assessed substantially comparable if:
a. There is evidence of recency of surgical practice in the relevant specialty;
and
b. There is evidence of completion of a specialist training program
comparable to RACS programs including the competencies, skills and
attributes; and
c. There is evidence of successful completion of an exit examination
comparable to RACS Fellowship Examination and/or the quantity, depth and
scope of surgical practice in the specialty is of a sufficiently high standard as
to waive the need to sit the Fellowship Examination.
In exceptional circumstances an IMG may be assessed as exceeding the standard of
substantial comparability to an Australian or New Zealand trained surgeon within a defined
scope of practice. Where the defined scope of surgical practice is considered valuable to
the community and conforms to the goals of RACS and specialty discipline, the IMG may be
recommended to Fellowship within this defined scope of practice.

Partially Comparable

An IMG will be assessed partially comparable if:

a. There is evidence of recency of surgical practice in the relevant specialty; and

b. There is evidence of completion of a specialist training program comparable to

RACS program including the competencies, skills and attributes; and

c. The applicant has not completed a comparable exit examination to RACS

Fellowship Examination and/or the quantity, depth and scope of surgical
practice in the specialty since the attainment of their surgical qualification
is not of a sufficiently high standard or duration as to waive the need to sit
the Fellowship Examination

Not Comparable
An IMG will be assessed not comparable if:
a. There is insufficient evidence of recency of specialist surgical practice in the
relevant specialty comparable to that of an Australian or New Zealand trained
surgeon in the specialty; or
b. There is insufficient evidence of completion of a specialist training program
comparable to RACS programs including the competencies, skills and
attributes;

Royal Australasian College of Surgeons 12

AREA OF NEED (AON) SPECIALIST ASSESSMENT
If you are an AoN applicant, the RACS process is the same as that outlined above for specialist
assessments, with some additional components that relate specifically to the AoN position.

You will be deemed to have comparability for an AoN position if:

• There is evidence of completion of a specialist training program comparable to the

College programs including the competencies, skills and attributes relevant to those
required for the AoN position, and
• There is evidence of recency of specialist surgical practice in the relevant specialty,
comparable to that of an Australian or New Zealand trained surgeon, within the defined
scope of practice relevant to the AoN position

All applicants for AoN positions are required to submit the required forms and supporting
documents via our online application system. For further information on AoN positions
applicants are advised to refer to the AoN specialist pathway, which is available on the AMC
website www.amc.org.au

An application for AoN assessment will require the requisite documentation as outlined for
specialist assessment on the RACS online application form and a RACS IMG Post Description
Form (IPDF), which is available on the RACS website https://www.surgeons.org/becoming-a-
surgeon/international-medical-graduates/contact,-guidelines-and-resources/

As with specialist assessments, the document based assessment is the same.

DEFINED SCOPE OF PRACTICE

To be eligible for a pathway to Fellowship as an IMG with a Defined Scope of Practice the
Clinical Director, IMG Assessments or the Board Representative must identify the defined scope
during the document assessment of the IMG’s application.

The Clinical Director, IMG Assessments and/or the Board Representative must be satisfied that
there is a public good derived from the defined scope of practice and that the IMG has:

a. Practiced as a consultant exclusively, and recently, for a minimum of 5 years since

completion of specialist surgical training in a defined scope of practice; and
b. Completed a specialist training program which is comparable to the modules of a
College training program specific to the defined scope of practice that includes
comparable competencies, skills and attributes; and
c. Successfully completed an exit examination for the training program that is comparable
to the College Fellowship Examination (but for the defined scope of practice): and/or the
depth and scope of surgical practice in the defined scope of practice is of a sufficiently
high standard as to waive the need to sit an exit examination.

An IMG cannot apply for assessment in Defind Scope of Practice.

Royal Australasian College of Surgeons 13

ONGOING ASSESSMENT

The requirement to undertake a period of assessment of clinical practice is made by the

Assessment Interview Panel as part of the Interim Recommendation.

Assessment of clinical practice may be undertaken on-site or off-site, either by Level 3

Supervision or by Level 4 Supervision.

Your requirements will also include:

• Completion of IMG orientation eLearning module
• Completion of RACS Operating with Respect eLearning module*
• Participation in the RACS’s Professional Development Activities
• Specified up-skilling in specific areas
• Specific courses or workshops
• Work-based assessment tasks

* will need to be completed prior to commencement of clinical assessment

Your requirement may also include:

• RACS Fellowship Examination
• Completion of Fellowship Examination eLearning module

The RACS may require you to complete additional assessments depending on your progress.

Further information on the assessment of clinical practice refer to the following policies and
guidelines available on the RACS website www.surgeons.org

 Assessment of the Clinical Practice of IMG’s in Australia policy

 Clinical Assessors of International Medical Graduates policy
 Guidelines for Partially Comparable IMGs undergoing Clinical Assessment
 Guidelines for Substantially Comparable IMGs undergoing Clinical Assessment

FINDING HOSPITAL EMPLOYMENT

If you proceed with the specialist assessment your next step will be to obtain a hospital position
that is suitable for conducting the assessment of your clinical practice. It is your responsibility to
find a suitable position. The College highly recommends that you refer to the Doctorconnect
website (www.doctorconnect.gov.au) where you will find information concerning specialist
recruitment agencies that may be able to assist you in finding a suitable position.

You need to ensure that the position you are seeking for clinical assessment purposes provides:

•appropriate scope of work

•the appropriateness of the designated Fellows to provide clinical assessment

•opportunities for continuing education and preparation for Fellowship Examination (if
applicable).

•the suitability of infrastructure for clinical assessment

Royal Australasian College of Surgeons 14

When you find a position that appears suitable you will be required to refer to the IMG
Assessment Post Accreditation policy and submit a RACS IMG Post Description Form (IPDF),
which is available on the College website and return the completed form to the Department of
IMG Assessments.

Applications for accreditation of an assessment post will only be assessed for IMGs who have
completed the RACS “Operating With Respect” eLearning module

The relevant Specialty Chair and/or IMG Representative will determine whether the position is
accredited for assessment purposes and confirm the suitability of the two clinical assessors
nominated on the IPDF who will monitor your progress throughout the assessment period. You
will be advised of the outcome of its review.

As previously advised if you are required to undertake a period of assessment of clinical

practice, either on-site or off-site, you will be subject to payment of an annual assessment fee.
Fees also apply to any additional courses or workshops you have been recommended to
undertake.

IMG ORIENTATION PROGRAM

You must complete the online IMG Orientation program as part of your specialist
assessment. The program is designed to familiarise you with the Australian health
environment in preparation for practice in Australia. Ideally you should complete the
program before commencing clinical assessment.

The program has seven modules covering multiple topics such as: cultural competency,
ethics and communication. There are no grades associated with the modules but you will
be asked to complete activities throughout the program. You must complete all activities
to satisfy your specialist recognition requirements. The Medical Board of Australia may
require demonstration of completion for registration purposes.

LEVEL 4 SUPERVISION

What is Level 4 Supervision?

Level 4 supervision is the review of the clinical practice of an IMG who does not require direct
supervision, and who has a significant degree of autonomy. The IMG is expected to take full
responsibility for each individual patient.

Level 4 supervision is used to ensure that the IMG’s performance is comparable to a locally
trained Australian and New Zealand surgeon. It is also a supportive process that helps
familiarize the IMG with the Australian health system and connects you with experienced
Australasian surgeons who can be mentors while you are new to specialist practice in Australia.

Level 4 Supervision requirements:

• The clinical assessor must periodically conduct a review of the IMG’s surgical practice.
• The Clinical Assessor must be available for consultation if the IMG requires assistance.
• The assessment of the IMG’s clinical practice can be performed on-site by local
surgeons appointed as clinical assessors or off-site by external surgeons (i.e. not
working in the same hospital as the IMG).

Royal Australasian College of Surgeons 15

IMG’s who are required to undertake Level 4 supervision are able to undertake clinical
assessment in approved Area of Need (AoN) positions.

What happens during Level 4 Supervision?

During Level 4 Supervision, the clinical assessors will assess the IMG to determine if they
are operating at the level of an Australian and New Zealand trained surgeon. Clinical
assessment requires the IMG to have regular meetings with their nominated clinical
assessors, and for the clinical assessors to provide supervision of the IMG’s clinical
practice.

LEVEL 3 SUPERVISION

What is Level 3 Supervision?

Level 3 Supervision is the review of the clinical practice of an IMG who has a limited degree of
autonomy. The IMG takes primary responsibility for each individual patient.

Level 3 supervision is used to ensure that the IMG possesses the necessary attributes to
achieve comparability to an Australian or New Zealand trained surgeon. In addition, on-site
Level 3 Supervision is provided to ensure quality of clinical practice, satisfactory general
progress, suitability to continue in the approved position, and preparedness to present for the
Fellowship Examination

Level 3 Supervision requirements:

 Level 3 supervision can only be performed locally (on-site).

 IMGs on a pathway to fellowship by examination (i.e. partially comparable) undertake

level 3 supervision.

 the clinical assessors must ensure that there are mechanisms in place for monitoring
whether the IMG is practising safely. This involves direct observation of the IMGs
clinical practice on a regular basis.

IMG’s who are required to undertake Level 3 Supervision are not able to undertake clinical
assessment in AoN positions unless:
• assessed with a subspecialty scope of practice specific to the AoN position

• 12 months of Level 3 supervision has been satisfactorily completed in a non AoN

position and the relevant specialty Board considers the post suitable for completion of
the remaining periods of assessment.

• 3 months of level 3 supervision has been satisfactorily completed in a major teaching or

tertiary hospital of the relevant specialty and the specialty board considers the post
suitable for completion of the remaining periods of assessment.

Royal Australasian College of Surgeons 16

What happens during Level 3 Supervision?

During Level 3 Supervision, the clinical assessors will assess the IMG to determine if they
possess the necessary attributes to achieve comparability to an Australian or New
Zealand trained surgeon. Clinical assessment requires the IMG to have regular meetings
with their nominated clinical assessors, and for the clinical assessors to have direct
observation of the IMG’s clinical practice on a regular basis.

Level 3 and Level 4 Supervision

Clinical assessors providing Level 3 and Level 4 supervision need to:

• ensure that they are accessible by telephone or video link if they are not physically
present; and
• conduct performance assessment meetings and provide constructive feedback to the
IMG; and
• complete periodic assessment reports as required by RACS. Assessors are expected to
liaise with other members of the hospital unit to ascertain the IMG’s performance across
all RACS competencies; and
• address any problems that are identified.

Both technical clinical skills and non-technical professional attributes described in the
RACS Surgical Competence and Performance are considered important. Whether the
IMG is on Level 3 Supervision or Level 4 Supervision, satisfactory reports of
competency are required in all specified domains.

Clinical assessors will provide regular reports to the RACS on the IMG’s progress under clinical
assessment.

These reports will be shared with the IMG.

If the IMG’s progress under clinical assessment is unsatisfactory or if the IMG fails an assessment,
the RACS may require the IMG to complete further assessments (in addition to or instead of
satisfactorily completing the failed assessment) and may revise downwards its Interim assessment
of the the IMG’s comparability.
For further information please refer to Management of Unsatisfactory Performance in the
Assessment of Clinical Practice in Australia policy on the RACS website www.

PROFESSIONAL DEVELOPMENT ACTIVITIES (PDA)

All IMG surgeons undergoing clinical assessment are required to participate in the College’s
Professional Development Activities. This program is managed through the College’s
Department of IMG Assessments. Further information is available on the College’s website
www.

MAINTENANCE OF PROFESSIONAL STANDARDS (MOPS)

An IMG must register for the MOPS program in January of the year following completion of
clinical assessment if they have not attained fellowship, and remain in that program until
Fellowship is attained or the pathway to Fellowship ceases.

Royal Australasian College of Surgeons 17

FELLOWSHIP EXAMINATION
The RACS Fellowship Examination is a requirement for IMGs who are assessed as partially
comparable to an Australasian trained surgeon.

Further information on the Fellowship Examinations is accessible on the RACS website www

FINAL ASSESSMENT
On the basis of satisfactory completion of
• the designated period of assessment of professional practice including prescribed
professional development activities, and/or
• the Fellowship Examination, and
• verification of both primary and specialist qualifications, and
• advice from the Chair or IMG Representative or relevant specialty Board
you would be eligible for Admission to Fellowship of RACS.

Once you have been awarded a Fellowship of RACS or advised by RACS as eligible for
Fellowship, you can apply to the Medical Board of Australia for specialist registration.

The RACS will provide a report (MBA Report 2) to AHPRA (via AMC portal) and a copy to
you, confirming that you have completed the RACS requirements for specialist recognition
and are eligible for specialist registration.

The RACS will also invite you to complete the relevant application forms for Admission to
Fellowship.

The RACS is not responsible for and cannot assist you with:

• applications for specialist registration

• applications for Medicare provider status.

ROLES AND RESPONSIBILITIES OF THE APPLICANT

Understanding the specialist assessment and area of need
assessment processes
The RACS IMG Department can guide you through the assessment process, but it is your
responsibility to familiarise yourself with all aspects of assessment, registration and
employment regulations in Australia. This includes understanding the role of the Australian
Medical Council, the RACS, the Medical Board of Australia and the Department of Human
Services (Medicare provider status) as well as organisations that can assist with
immigration and employment opportunities.

You should research prospective employment opportunities in Australia and ensure you are
aware of the timeframes for completing ongoing assessment requirements that are required by
the MBA and the RACS. Grounds for extensions will be considered in particular
circumstances.

You should contact the RACS for further information before your assessment expires.

Royal Australasian College of Surgeons 18

TIMEFRAMES
The RACS specialist assessment and/or Area of Need process normally takes up to 3 months
(from date of activation) to complete.

Where possible the College will arrange an interview within the specific timeframes outlined
above.

VALIDITY OF THE ASSESSMENT

The College will advise you of the Interim Recommendation and ask you to notify the College,
in writing, of your decision to comply with its requirements. You will have 20 Victorian working
days from date of recommendation to respond.

If you are required to undertake a period of assessment of clinical practice under Leve 3 or
Level 4 supervision, this period of assessment must be commenced within twenty-four months
of the Interim Recommendation date; otherwise the Interim Recommendation expires.

All elements of the recommendation, including the Fellowship Examination, if applicable, must
be completed within four (4) years from the date that the assessment of clinical practice period
commences; otherwise the recommendation expires.

DUTY TO DISCLOSE ALL RELEVANT INFORMATION

It is your responsibility to communicate adequate information to support the assessment
of your comparability with an Australasian trained surgeon at all stages of the specialist
assessment process. You must fully and openly disclose all information that may be
relevant throughout the application, Interim assessment, ongoing assessment and final
assessment processes. Non-disclosure of relevant information may result in the RACS
rejecting your application.

COMMUNICATION WITH THE RACS AND CLINICAL ASSESSORS

You must communicate to the RACS any change in circumstances that has an impact on
your application, Interim assessment, ongoing assessment or final assessment decision.
This includes a duty to clearly communicate any changes to your clinical assessment
arrangements. You must notify the RACS as soon as possible if you consider that the
arrangements with your clinical assessors are not operating effectively or that your
clinical assessors are not meeting their responsibilities.

For information on Specialist and/or AoN Assessments in Australia

contact:

IMG Assessment Department

Royal Australasian College of Surgeons
250-290 Spring Street
East Melbourne, Victoria, 3002

Telephone: +61 3 9249 1112

Royal Australasian College of Surgeons 19

Email: [email protected]

IMGs who want to work in New Zealand

If you are an International Medical Graduate with formal postgraduate specialist

qualifications, and wish to attain registration to practice as a surgeon in New Zealand,
you will need to contact the Medical Council of New Zealand.

Medical Council of New Zealand

PO Box 11649
Wellington NEW ZEALAND

Telephone: +64 4 385 8247

Website: http://www.mcnz.org.nz

Visa requirements

For information on each country’s visa requirements, contact the Department of

Immigration and Multicultural Affairs (Australia) and/or the New Zealand Immigration
Department.

Complaints and Appeals

The RACS has implemented a formal process for handling complaints and appeals.
These must be lodged within three months of receipt of notice of original decision.

Requests for review or reconsideration of College decision must be lodged in writing

and sent to:

The Manager
IMG Assessment Department
Royal Australasian College of Surgeons
250-290 Spring Street
East Melbourne, Victoria, 3002

Complaints or appeals must be lodged in writing and sent to:

The RACS Executive Director of Surgical Affairs

Royal Australasian College of Surgeons
250-290 Spring Street
East Melbourne, Victoria, 3002

Further details may be obtained by referring to the Appeals Mechanism policy on the
College website.

Royal Australasian College of Surgeons 20

 Guidelines & Forms

Guidelines and forms used during the application process are available on the College’s
website.

Policies

For further information, the College recommends that you refer to the following policies:

 Specialist Assessment of International Medical Graduates in Australia

policy
 Comparable Specialist Surgical Training and Exit Examination in
Cardiothoracic Surgery
 Comparable Specialist Surgical Training and Exit Examination in General
Surgery
 Comparable Specialist Surgical Training and Exit Examination in
Neurosurgery
 Comparable Specialist Surgical Training and Exit Examination in
Orthopaedic Surgery
 Comparable Specialist Surgical Training and Exit Examination in
Otolaryngology Head and Neck Surgery
 Comparable Specialist Surgical Training and Exit Examination in
Paediatric Surgery
 Comparable Specialist Surgical Training and Exit Examination in Plastic
and Reconstructive Surgery
 Comparable Specialist Surgical Training and Exit Examination in Urology
 Comparable Specialist Surgical Training and Exit Examination in
Vascular Surgery
 IMGs Interview Panels in Australia Terms of Reference policy
 Assessment of Clinical Practice of International Medical Graduates in
Australia
 Clinical Assessors of International Medical Graduates in Australia policy
 IMGs Assessed with a Defined Scope of Practice policy
 Professional Development Opportunities for IMGs
 International Medical Graduates Fees
 IMG Misconduct
 IMG Agreement
 Appeals Mechanism Policy
 IMG Assessment Post Accreditation

These documents are all available on the College website (www.surgeons.org).

Additional information and links

Further information on IMG specialist assessment is available on the following websites:

• College website (www.surgeons.org)
• Medical Board of Australia (www.medicalboard.gov.au)
• Australian Health Practitioner Regulation Agency (www.ahpra.gov.au)
• DoctorConnect (www.doctorconnect.gov.au
• Australian Medical Council (www.amc.org.au)

Royal Australasian College of Surgeons 21

 • AMC portfolio (https://portal.amc.org.au)
• Educational Commission for Foreign Medical Graduate’s (ECFMG) Electronic
Portfolio of International Credentials (EPIC)
(http://www.ecfmgepic.org/physicians.html)
• New Zealand Medical Council (www.mcnz.org.nz)

DEFINITIONS
AHPRA Australian Health Practitioner Regulation Agency
AMC Australian Medical Council
AON Area of need
Comparability A determination of how the IMG’s education, training and experience
including recency of practice compares with the standard of an
Australasian trained surgeon in the same specialty currently entering
the workforce.
Competency An assessment of an OTP’s level of clinical practice compared
with the standard of an Australian trained specialist in the same
specialty currently entering the workforce.
MOPS Maintenance of Professional Standards

PDA Professional Development Activities

MBA Medical Board of Australia
IMG International Medical Graduate
PSV Primary source verification
RACS Royal Australasian College of Surgeons
Registration body The government body empowered by law to register medical
practitioners (at

Royal Australasian College of Surgeons 22