Intern training – Assessing and certifying

completion

Introduction
This document details requirements for assessing interns participating in accredited intern
training programs, and for certifying completion of internship. It should be read in conjunction
with:

 Registration standard – Australian and New Zealand graduates

 Intern training – National standards for programs
 Intern training – Intern outcome statements
 Intern training – Term assessment form
 Intern training – Guidelines for terms.

Assessing interns
Notes on terminology
Interns can complete supervised terms and training in various health care settings, including
hospitals, general practices and community-based medical services. In this document, the key
roles in the intern assessment process are those commonly used in hospitals:
 Director of Medical Services, for the senior medical administrator who leads the
medical workforce at a facility
 Director of Clinical Training, for the individual with responsibility for
implementing the intern training program
 Term Supervisor, for the senior clinician responsible for intern orientation and
assessment during a particular term.

These roles, albeit with different titles, will apply in non-hospital settings and the requirements
in this document apply accordingly.
These national standards use the terms specified in the glossary at the end of the document.

Assessment approach
The basis for this assessment approach is contained in Intern training – National standards for
programs. Standard 5.1.1 requires assessment that is consistent with the Registration standard –
Australian and New Zealand graduates. Assessment must be based on interns achieving
outcomes stated in Intern training – Intern outcome statements (5.1.2) and it must be
understood by supervisors and interns (5.1.3).

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Therefore, assessing interns has three distinct imperatives:
 First, the process must be clear and transparent for all involved.
 Second, assessment must capture the essential information that intern training
providers must provide to the Medical Board of Australia for determining
whether interns have met the registration standard. See page 4 for more
information.
 Third, the assessment process must be based on outcomes consistent with the
national standards. To achieve this, interns must be assessed against the Intern
training – Intern outcome statements.

Assessment forms
Assessment of intern training is work-based and term supervisor reports have a key function. In
this national registration system a consistent approach to assessment is supported with a
nationally available tool, the Intern training – Term assessment form. The form's development
was informed by the work of the Confederation of Postgraduate Medical Education Councils
(CPMEC) during 2008 and 2009, literature on assessment, and stakeholder feedback on draft
forms and draft guidance during 2012 and 2013.

Scoring
The Intern training – Term assessment form requires intern performance to be rated against the
intern outcome statements on a five point scale (1–5). The form provides behavioural anchors
for each outcome statement for scale points 1, 3 and 5. Supervisors should refer to these
anchors to assist them in allocating ratings and providing appropriate feedback.
The form also requires a global score to assist in determining overall satisfactory performance,
as required in the Registration standard – Australian and New Zealand graduates. In assigning
global scores, term supervisors should consider both the individual 1–5 ratings on the
assessment form, and the global abilities of interns to:
 practise safely
 work with increased levels of responsibility
 apply existing knowledge and skills
 learn new knowledge and skills as required.

Global scores should be based on a clear understanding of the intern’s role as a supervised,
beginning practitioner who is not yet fully independent, and the accumulated knowledge and
judgement of term supervisors from their experience in intern training and assessment. Global
scores should be assigned at three levels:
 Satisfactory – the intern has met performance expectations in the term.
 Borderline – further information, assessment and remediation may be required
before the intern can demonstrate they meet performance expectations in the
term.
 Unsatisfactory – the intern has not met performance expectations in the term.

Local forms
Intern training providers may substitute locally developed forms for the national form. In such
cases, the providers must demonstrate the locally developed forms meet national standards
5.1.1, 5.1.2 and 5.1.3.

Assessor training
Under national standard 5.3, intern training providers must have processes for ensuring those
assessing interns have the relevant capabilities and understanding of the processes involved.

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Intern training providers should therefore incorporate specific training in using assessment
forms, whether nationally or locally developed, in their supervisor support and development
programs, in addition to general training in assessment and feedback skills. Training may also
include supervisor 'frames of reference' and calibration of ratings to improve reliability and
validity of the assessment processes.

Feedback and performance review

National standards 5.2.1–5.2.6 address feedback and performance review. Intern training
providers must:
 provide regular feedback to interns on their performance (5.2.1)
 document assessment performance (5.2.2)
 ensure feedback from supervisors is received each term (5.2.3)
 encourage interns to take responsibility for their own performance and to seek
feedback (5.2.4)
 have clear procedures to immediately address patient safety concerns (5.2.5)
 identify interns who are not performing to the expected level and organise early
appropriate remediation (5.2.6).
To meet these standards, term supervisors should assess interns at the end of each term. For
terms longer than five weeks, term supervisors should also assess interns at the term’s mid-
point. Interns should also complete self-assessments of their performance, and discuss these
with the term supervisor at the mid-term (if relevant) and end-of-term assessment meetings.
Feedback should be provided to interns at these meetings.
The Director of Clinical Training (or equivalent) should review term supervisor assessments
with assistance, where possible, from medical education officers. Interns with satisfactory
global scores continue in their internship.

Remediation
Where the term supervisor identifies a performance issue, early remediation is essential. The
Director of Clinical Training (or equivalent) should discuss the circumstances with the term
supervisor and the intern, and implement a tailored plan to improve performance. The plan
should document the specific actions and deadlines jointly agreed to improve the intern’s
performance, and enable progress to be tracked. A plan such as the Improving Performance
Action Plan (IPAP)available on the AMC website.
Additional remediation is required where there is continuing concern about an intern’s
performance. Normally, the Director of Clinical Training would make this decision, initiate the
remediation, and communicate the requirements directly to term supervisors and the Director
of Medical Services. Additional remediation is indicated when intern performance:
 does not meet the requirements of one of the terms, and/or
 does not satisfy the requirements of a previous remediation plan, and/or
 raises sufficiently complex issues during the scheduled term supervisor
assessment to require more detailed consideration and action.

Additional remediation may include undertaking a period of very close supervision and/or
additional work in emergency medical care, medicine and surgery in lieu of other terms or
experiences.
There may be circumstances where the intern training provider considers it not appropriate to
offer the intern additional remediation within that employment period, or that remediation is
unlikely to be successful. The intern training provider should report this to the Medical Board of
Australia, using the same process of certifying completion of internship described below.

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All decisions regarding additional remediation or non-completion of a term must be clearly
documented and communicated directly to the Director of Medical Services. This will ensure
that the employer is informed about these aspects of intern performance.

Notifiable conduct
The requirement under national standard 5.2.5 to immediately address concerns about patient
safety will require action beyond remediation, including possible withdrawal of an intern from
the clinical context. Intern training providers and employers must also be aware of sections 141
and 142 of the National Law. This requires registered health practitioners and employers to
make notifications about registered medical practitioners who have engaged in ‘notifiable
conduct’ as defined in section 140 of the National Law. Notifiable conduct by interns must be
reported to the Medical Board of Australia immediately.

Assessment review and quality

Under national standard 5.2.7, intern training providers must establish review groups to assist
with more complex decisions on remediation. A senior clinician with experience in educating
and training interns should chair the group. Given the close nexus between training and
employment concerns in internship, the review group should include employer representatives
and relevant educators. Assessment review groups should have clear and transparent
procedures for deciding on any course of action and for resolving disputes and appeals.

National standard 5.1.4 requires intern training providers to use intern assessment data in
improving intern training programs. This should include centralised tracking and collating of
assessment forms, and analysing assessment outcomes. The data should be reported to the
health service and should inform intern supervisor training and support processes. Assessment
review groups, or the committee with oversight of intern education and training, may undertake
these functions.

Certifying completion of intern training

Intern training providers are required to certify completion of internship. On the basis of the
information provided, the Medical Board of Australia makes the decision on granting general
registration to the intern. The form for use in certifying internship completion, Certificate of
completion of an accredited internship, is available on the Medical Board of Australia’s website.
The Medical Board of Australia requires only the completion of the Certificate of completion of
an accredited internship form. Term assessment reports and supporting documentation,
including outcomes of remediation, should be stored by the training provider in the case that
additional information is sought by the Board.

The Medical Board of Australia’s requirements for certification, as per the

Registration standard – Australian and New Zealand graduates, are summarised
below:

 Evidence the intern has satisfactory completed at least 47 weeks equivalent full-
time experience in supervised clinical practice.
 Evidence the intern has performed satisfactorily under supervision in terms that
provide 8 weeks' experience in emergency medical care, 10 weeks in medicine
and 10 weeks in surgery.
 Written confirmation that the intern has met the above requirements, including
satisfactory Term Supervisor reports, and an overall satisfactory rating awarded
by the Director of Clinical Training, the Director of Medical Services or other
authorised person.

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The Medical Board of Australia has further clarified these requirements as:
Term supervisors are expected to indicate whether interns have satisfactorily
‘passed’ each term, but the Medical Board will consider the totality of advice in
deciding whether to grant general registration. An intern who has performed
marginally or unsatisfactorily in a specified term but who has demonstrated
‘significant’ progress with evidence of remediation may be deemed to have met the
standard expected for general registration by the end of the year.
This additional clarification allows for a longitudinal approach to assessment during internship.
Intern training providers may indicate that a particular term has not been completed
satisfactorily. However, if remediation has been successful the provider may tick the box at the
end of the Medical Board of Australia’s Certificate of completion of an accredited internship
indicating that the intern has met the standards expected for general registration at the end of
the year.

Supporting documents
The following references are mentioned specifically within this document:
 Registration standard – Australian and New Zealand
 Intern training – National standards for programs
 Intern training – Intern outcome statements
 Intern training – Term assessment form
 Intern training – Guidelines for terms
 National Law

Full information for all documents relevant to the intern training suite is available below.

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Intern training reference documents

Document Full reference

AMC documents
Intern training – Intern Intern training – Intern outcome statements [Internet]. Canberra:
outcome statements Australian Medical Council; 2013 [cited 2013 Dec 18]. Available from:
http://www.amc.org.au/index.php/ar/psa. Joint publication of the Medical
Board of Australia.
Intern training – National Intern training – National standards for programs [Internet]. Canberra:
standards for programs Australian Medical Council; 2013 [cited 2013 Dec 18]. Available from:
http://www.amc.org.au/index.php/ar/psa. Joint publication of the Medical
Board of Australia.
Intern training – Intern training – Guidelines for terms [Internet]. Canberra: Australian
Guidelines for terms Medical Council; 2013 [cited 2013 Dec 18]. Available from:
http://www.amc.org.au/index.php/ar/psa. Joint publication of the Medical
Board of Australia.
Intern training – Term Intern training – Term assessment form [Internet]. Canberra: Australian
assessment form Medical Council; 2013 [cited 2013 Dec 18]. Available from:
http://www.amc.org.au/index.php/ar/psa.
Intern training – Assessing Intern training – Assessing and certifying completion [Internet]. Canberra:
and certifying completion Australian Medical Council; 2013 [cited 2013 Dec 18]. Available from:
http://www.amc.org.au/index.php/ar/psa. Joint publication of the Medical
Board of Australia.
Intern training – Domains Intern training – Domains for assessing accreditation authorities [Internet].
for assessing accreditation Canberra: Australian Medical Council; 2013 [cited 2013 Dec 18]. Available
authorities from: http://www.amc.org.au/index.php/ar/psa. Joint publication of the
Medical Board of Australia.
Guide to intern training in Guide to intern training in Australia [Internet]. Canberra: Australian Medical
Australia Council; 2013[cited 2013 Dec 18]. Available from:
http://www.amc.org.au/index.php/ar/psa. Joint publication of the Medical
Board of Australia.
Other documents
Australian Curriculum Australian Curriculum Framework for Junior Doctors [Internet]. Melbourne:
Framework for Junior Confederation of Postgraduate Medical Education Councils (CPMEC); 2012
Doctors [cited 2013 Sep 09]. Available from:
http://curriculum.cpmec.org.au/index.cfm
Registration standard – Registration standard – Granting general registration as a medical
Australian and New practitioner to Australian and New Zealand medical graduates on
Zealand graduates completion of intern training [Internet]. Canberra: Medical Board of
Australia; 2012 [cited 2013 Sep 09]. Available from:
http://www.medicalboard.gov.au/Registration-Standards.aspx
Certificate of completion Certificate of completion of an accredited internship [Internet]. Melbourne:
of an accredited internship Medical Board of Australia; 2014 [cited 2014 Jul 15). Available from:
http://www.medicalboard.gov.au/Registration/Interns/Guidelines-
resources-tools.aspx
Good Medical Practice: A Good Medical Practice: A Code of Conduct for Doctors in Australia
Code of Conduct for [Internet]. Canberra: Medical Board of Australia; 2010 [cited 2013 Sep 09].
Doctors in Australia Available from: http://www.medicalboard.gov.au/Codes-Guidelines-
Policies.aspx
National Law Health Practitioner Regulation National Law, as enacted in each state and
territory [Internet]. Available from: http://www.ahpra.gov.au/Legislation-
and-Publications/Legislation.aspx

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Next review of this document
By December 2017.

Approval
Australian Medical Council – 16 September 2014
Medical Board of Australia – 24 September 2014

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Glossary
Assessment The systematic process for measuring and providing feedback on the intern’s
progress or level of achievement. This assessment occurs in each term against
defined criteria.

Global rating A rating based on the overall performance of the intern against the requirements
for general registration. It is based on the assessor's accumulated experience in
supervising and assessing interns.

Descriptions Phrases used to describe the behaviour/s that will have been observed by the
supervisor and/or others to indicate the intern is performing at the specific level.

Certification The final sign-off to the Medical Board of Australia that the intern has completed
the statutory requirements for general registration.

Clinical A medical practitioner who supervises the intern while they are assessing and
supervisor managing patients. The AMC defines a suitable immediate clinical supervisor as
someone with general registration and at least three years' postgraduate
experience. The Primary Clinical Supervisor should be a consultant or senior
medical practitioner.

Director of A senior clinician with delegated responsibility for implementing the intern
Clinical Training training program, including planning, delivery and evaluation at the facility. The
Director of Clinical Training also plays an important role in supporting interns with
special needs and liaising with term supervisors on remediation. Also known as the
Director of Prevocational Education and Training (DPET) in some states. Other
terms may be used in community or general practices.

Director of A senior medical administrator who leads the medical workforce at a facility and
Medical Services certifies an intern has satisfactorily completed an accred internship. Also known as
the Executive Director of Medical Services (EDMS). Other terms may be used in
community or general practices.

Formal education An education program the intern training facility provides and delivers as part of
program the intern training program curriculum. Sessions are usually weekly and involve a
mixture of interactive and skills-based face-to-face or online training.

Intern A doctor in their first postgraduate year and who holds provisional registration
with the Medical Board of Australia.

Intern training A period of 47 weeks of mandatory, supervised, work-based clinical training that
program includes medicine, surgery and emergency medical care terms to meet regulatory
requirements. The program also includes orientation, formal and informal
education sessions and assessment with feedback, and it may be provided by one
or more intern training providers. Also called PGY1.

Intern training The organisation that provides supervised clinical practice, education and training,
provider and that is responsible for the standard of the intern training program. Providers
may be a hospital, community, general practice setting, or a combination of these.

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PGY Postgraduate year, usually used with a number to indicate the number of years
after graduation from medical school. For example, PGY1 is the first postgraduate
year, also known as internship.

Term A component of the intern training program, usually a nominated number of weeks
in a particular area of practice. Also called clinical rotation, post, or placement.

Term Supervisor The person responsible for intern orientation and assessment during a particular
term. They may also provide clinical supervision of the intern along with other
medical colleagues.

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