IMG Orientation Power Point v1.4

Living and working in WA
An orientation guide
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Medical Board of Australia – IMG supervision
(Manual section ‘helpful information’
The Medial Board of Australia introduced international medical

graduate (IMG) Supervision Guidelines on 04 January 2016, including
an orientation report.
• Orientation to the Australian healthcare system

• Orientation to the hospital/practice
• Orientation to legislation and professional practice
• Professional development
• Cultural diversity and social context of care
• Other topics
Further information: http://

www.medicalboard.gov.au/Registration/International-Medical-Graduate
s/Supervision.aspx
3
Australian healthcare system
(Manual section 1)
Topics covered
 Australian Government and key health
organisations
 Medicare
 Pharmaceuticals Benefit Scheme
 Department of Veterans’ Affairs
 private health services
4
Australian states and territories
Australia is a Federation of 6 states

and 2 territories:
States
New South Wales (NSW)
Queensland (QLD)
South Australia (SA)
Tasmania (TAS)
Victoria (VIC)
Western Australia (WA)
Territories
Australian Capital Territory (ACT)
Northern Territory (NT)
5
Australian time zones
(Manual section 1)
There are 3 time zones in Australia:

 Australian Eastern Standard Time (AEST)
 Greenwich time add 10 hours
 Applies to ACT, NSW, VIC, TAS, QLD
 Australian Central Standard Time (ACST)
 AEST subtract 30 minutes
 Applies to SA and NT
 Australian Western Standard Time (AWST)
 AEST subtract 2 hours
 Applies to WA
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(Manual section 1)
The Australian healthcare system is complex and comprises a

mix of public and private service providers supported by
legislative, regulatory and funding arrangements.
 Funding is provided by all levels of government, health insurers,
non-government organisations and individuals.
 The Australian Government is responsible for the three national
health subsidy programs: Medicare, Pharmaceutical Benefits
Schemes and the private health insurance rebate.
 State and territory governments are responsible for delivery of
public health services including public hospitals, population health,
public and community health services and mental health.
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Three levels of Government
Australian Government
State Government Federal Government
Medicare Australia
Medicare PBS Other programs
Public hospital Private patient –

hospital treatment
Other programs
Private practice
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Federal Government funding provides
 Medicare
 Pharmaceutical Benefits Scheme
 aged care services (e.g. nursing homes)
 primary care services (e.g. general practice)
 Private health insurance rebate
 health services for specific population groups
 Defence Force personnel through
Department of Veterans’ Affairs
 Aboriginal communities
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Department of Veteran’s Affairs - DVA
(Manual section 1.4)
 Supports those who serve or have served in Australian

Defence Forces.
 Provides a broad range of health care and support services to
eligible veterans and their dependants through DVA and
various health service providers.
 Veterans’ Home Care
 public and private hospital care
 respite care
 community nursing
10
The Gold Card Repatriation Health Card - For All Conditions
Gives you access to a wide range of public
and private health care services, for the
treatment, at the department’s expense, of all
your health care conditions whether war or
service related or not.
The White Card Repatriation Health Card - For Specific Conditions

Gives access to a wide range of public and
private health care services for the treatment,
at the department’s expense, of your
disabilities and conditions accepted as war or
service related.
The Orange Card Repatriation Pharmaceutical Benefits Card

Gives access to subsidised pharmaceuticals
and medicines under the Repatriation
Pharmaceutical Benefits Scheme (RPBS). The
Orange Card is issued to Commonwealth and
allied veterans and mariners who meet the
eligibility criteria.
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The Commonwealth Seniors Health Card
Available to eligible veterans, partners, and
war widow(er)s who do not receive an income
support pension from DVA or a pension or
benefit from Centrelink.
Must meet an annual adjusted taxable income
test.
Other DVA eligibilities
• DVA may pay travel expenses, or make transport bookings, for you to attend the health provider
closest to your residence (conditions apply).
• The Repatriation Pharmaceuticals Benefit Scheme (RPBS) provides a wide range of

pharmaceuticals and dressings at a concessional rate for the treatment of eligible veterans, war
widow(er)s, and their dependants.
• The Veterans’ Pharmaceutical Reimbursement Scheme (VPRS) is an annual reimbursement for

eligible veterans for out–of-pocket costs associated with the concessional pharmaceutical co-
payment. It is paid automatically if eligible.
12
Medicare
What is Medicare?
 Australia's universal health insurance scheme
 A range of medical services, lower cost prescriptions and free
care as a public patient in a public hospital
How is Medicare funded?

 Australian taxpayers contribute through the taxation system
 Medicare levy – 2% of taxable income
 Medicare levy surcharge – taxpayers with a certain level of
taxable income who don’t have private health insurance
may pay additional tax
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Medicare cards
Issued to all people eligible to access health services under

Medicare and is used when
 visiting a doctor and using electronic claiming
 submitting a claim form at a Medicare office
 making enquiries with Medicare
 seeking treatment as a public patient in a public hospital
 filling a prescription at a pharmacy.
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The Green Medicare Card
The standard Medicare card for Australian citizens and
permanent residents. This card is issued to individuals or
families who are eligible to receive a rebate of medical
expenses under the Australian Medicare system when they
are treated privately by a doctor with a provider number.
The Yellow Medicare Card

For visitors from countries with reciprocal health care
agreements: Belgium, Finland, Italy, Malta, the Netherlands,
New Zealand, Norway, the Republic of Ireland, Slovinia,
Sweden and the United Kingdom. Visitors from these
countries are covered for publicly funded necessary health
care (e.g. emergency care; care for an illness or injury that
can not wait until return home) in Australia. Australians are
covered in the same way when visiting these countries.
The Blue Medicare Card

A visitor or interim card, for a person who has temporary
residency and is applying for permanent residency. There
are no restrictions on these cards, except that they are
usually issued for a twelve month period. The expiry date
must be checked for validity.
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Access to Medicare services
 Eligible patients can access free public hospital services and

after-care provided through the hospital. The hospital assigns
the treating doctor.
 Patients can opt to be admitted as a private patient in a public

hospital
 can select their own doctor
 patient will be charged hospital
and medical fees by the public
hospital
 medical insurance may cover
these costs.
16
Medicare services
 The Australian Government Department of Human Services

provides on-line learning modules and other information
resources for health professionals
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Medicare Benefits Schedule
 The online Medicare Benefits Schedule - MBS Online -

provides the latest MBS information
 Can search the MBS by Item numbers and/or key words
18
Pharmaceutical Benefits Scheme
 Subsidy scheme for prescription medicines. Eligible people

can access certain prescription medicines at reduced cost.
 Approximately 80% of prescriptions dispensed are
subsidised through the PBS.
 Only drugs listed on the Pharmaceutical Benefits Schedule
(‘the Schedule’) are subsidised.
 The Schedule details clinical conditions and other criteria to
be met for a patient to qualify for a PBS medicine.
 Doctors must ensure that PBS medicine is prescribed in
accordance with PBS requirements.
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PBS restrictions on prescribing
 Unrestricted: can be prescribed without PBS restrictions on

therapeutic use in accordance with the Therapeutic Goods
Administration (TGA)
 Restricted: can be prescribed if the prescriber is satisfied the patient's
clinical condition matches the therapeutic uses listed in the Schedule
Authority Required (two categories):
 Authority Required - requires prior approval from the Department
of Human Services or DVA
 Authority Required (Streamlined) - does not require prior approval
from Department of Human Services or DVA but must have the
relevant streamlined Authority code included on the prescription
(can be done electronically).
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Patient categories under the PBS
 General category: pay the cost of dispensed medicines up to a

maximum amount per item, PBS pays cost of the drug over that
level.
 Concessional category: pay significantly less than general
category for PBS prescribed drugs. Must be eligible for
Medicare and meet specific criteria that qualify them to be
declared disadvantaged.
PBS online learning

 The Australian Government Department of Human Services
provides educational resources on prescribing and using the
PBS correctly
21
Provider and prescriber numbers
To provide services funded by Medicare, doctors must apply for

provider and prescriber numbers.
Medicare provider number

 Used for referral and diagnostic test requests.
 Identifies the medical practitioner and the location where they
work. Doctors can have multiple provider numbers.
PBS prescriber number

 Must be included on prescription when prescribing under PBS.
 Is automatically issued with the initial provider number. Doctors
have one prescriber number throughout their career.
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Private health system
• Works in tandem with Medicare to reduce the demand on

public hospital services.
• Includes privately operated hospitals and health care centres
which provide services to fee-paying patients.
• Some private hospitals are contracted by the State
Government to provide services to public patients.
• Private hospitals currently providing public patient services in
WA are:
– Joondalup Health Campus (northern metropolitan)
– St John of God Midland Public Hospital (eastern
metropolitan)
– Peel Health Campus (south metropolitan)
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Western Australian health system
(Manual section 2)
Topics covered
 WA Government and structure of public health system
 metropolitan health services
 country health services
 other health service providers in WA
 Emergency service providers
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WA public health system
In March 2017 the estimated WA population was just under 2.6 million.
 Most people (80%) live in the Perth metropolitan area with the rest of the
population spread across country areas.
The public health system, known as WA Health, consists of:

 The Department of Health
 Five Health Service Providers (HSPs) – six from July 2018
 Health Support Services
The Department of Health is led by the Director General and provides

leadership and management of the whole health system.
The HSPs are governed by Health Support Boards.
Each HSP is responsible for their local areas and communities.
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WA public health services
WA public HSPs include:
 Metropolitan Health Service

 Child and Adolescent Health Service
 North Metropolitan Health Service
 South Metropolitan Health Service
 East Metropolitan Health Service
 PathWest Laboratory Medicine WA (PathWest) – from July 2018
 WA Country Health Service (WACHS)

 Seven health regions
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Metropolitan Health Service
Child and Adolescent Health Service

 Princess Margaret Hospital for Children (PMH)/Perth Children’s Hospital
 Community health and mental health services (CACH, CAMHS)
North Metropolitan Health Service

 Sir Charles Gardiner Hospital, King Edward Memorial Hospital, Graylands Hospital,
Osborne Park Hospital
 Joondalup Public Hospital
South Metropolitan Health Service

 Fiona Stanley Hospital, Fremantle Hospital, Rockingham General Hospital, Fremantle
Hospital, Murray District Hospital
 Peel Health Campus (public/private partnership)
East Metropolitan Health Service

 Armadale/Kalamunda Group, Royal Perth/Bentley Group
 St John of God public hospital Midland
PathWest Laboratory Medicine WA (PathWest)

 From July 2018
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WA Country Health Service
 Region of over 2.5 million km2

 70 hospitals
 A number of smaller health centres and
nursing posts
 Indigenous health, population health,
mental health and aged care services.
Seven health regions

 Goldfields
 Kimberley
 Midwest
 Pilbara
 Great Southern
 South West
 Wheatbelt
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WA Health - other services
(Manual section 2.4 – 2.8)
 Health@Home supports patients in their home to retain

independence and minimise hospital admissions.
 Dental Health Service provides emergency and general dental

care for eligible persons.
 Public Health Division focuses on prevention and early detection

across the whole population, seeking to manage risks.
 Mental Health services are overseen by the Mental Health Unit.
 Private health services include a network of private hospitals and

general practice clinics.
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Community-based health services
 Aged Care Assessment Team (ACAT): teams of health

professionals who assist older people and their carers determine
the level of care needed to enable the older person to remain at
home or find alternate care.
 Disability Services: a government department responsible for
advancing opportunities, community participation and quality of life
for people with disability.
 Home and Community Care (HACC): provides basic support

services to some older people, people with a disability and their
carers to assist them to continue living independently at home.
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Community-based health services
 Hospital in the Home (HITH): provides hospital care in the

patient's own home, under the care of the hospital doctor, receiving
the same treatment that they would have received had they been in
a hospital bed.
 Silver Chain: provides a range of clinical and health care services

to assist people of all ages and their carers, including the elderly
and people with disabilities, illness and injury, to maintain their
health at home in metropolitan as well as country and remote WA.
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Other organisations
 Aboriginal Health Council of WA (AHCWA): the peak body for the

21 individual Aboriginal Community Controlled Health Services that
are run by local Aboriginal people and their communities to manage
their own health and well-being in accordance with protocols and
procedures determined by their community members.
 Sexual Health Quarters (SHQ): an independent, non-profit
organisation and the leading provider of sexual and reproductive
health services in WA offering a range of services.
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Emergency service providers
 Poisons Information Centre (WAPIC): a specialised unit that

provides expert advice on the management of poisonings or
suspected poisonings. Contact: 13 11 26
 Newborn Emergency Transport Service (NETS): coordinates

emergency transfer of newly born babies from their hospital of birth
to PMH or KEMH for intensive care. Contact: 1300 638 792
 Royal Flying Doctor Service (RFDS): is a not-for-profit service

providing aero medical retrievals and transfers, as well as 24 hour
emergency services, telehealth, mental health and primary health
care services. Contact: 1800 625 800.
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Emergency service providers
 St John Ambulance Australia (SJA): is the primary provider of

pre-hospital care services in WA. Patients are charged for services
provided, for both emergency and non-urgent ambulance transfers
and treatment. Contact: 000 for emergency services
 Sexual Assault Resource Centre (SARC): provides a 24 hour

emergency service in metropolitan Perth involving medical care,
forensic examination and counselling support to people who have
been sexually abused in the previous 14 days. SARC offers a free
confidential service. Contact: 1800 199 888 or 6458 1828
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Communication and cultural awareness
(Manual section 3)
Topics covered
 Australian society
 Aboriginal Australians
 Australian patients
 cultural awareness
 communication
 cultural awareness training
 professional conduct
35
Australian society
 Australia has a democratic, culturally diverse society which elects a

government every 3 to 4 years.
 Australian principles and values are based on a premise of equal
opportunity, mutual respect and tolerance.
 As a multicultural society there are few social customs which are
specific to Australia.
 People are generally informal with friends and work colleagues,
referring to each other by their first name.
 Detailed information about Australian culture is available on the
Department of Immigration and Border Protection website
36
Aboriginal Australians
 Aboriginal and Torres Strait Islander people are the original (indigenous)
inhabitants of Australia.
 Aboriginal people tend to be more visual and verbal in communication,
and there is much emphasis on imparting knowledge and culture through
art, rituals and story‐telling.
 Aboriginal people, as a whole, experience disproportionate levels of
disadvantage and poorer health compared with other Australians.
 Aboriginal people overall experience a greater burden of disadvantage
and have a higher risk of developing chronic disease and suffering injury.
 The “Closing the Gap” reform agenda aims to close the life expectancy
gap between Aboriginal and non- Aboriginal Australians within one
generation and provide a better future for Aboriginal children.
37
Aboriginal patients - resources
 Newly arrived medical practitioners are encouraged to develop links

with a local community representative and an Aboriginal health worker
to assist in their care of Aboriginal patients.
 Byalawa: research-based multimedia learning and teaching resources

to facilitate appropriate, culturally-safe interviewing and case history
taking skills.
 Aboriginal Primary Health Care is a comprehensive, technical resource

on best-practice management of the major health problems facing
Aboriginal peoples and Torres Strait Islanders.
 The Remote Primary Health Care Manuals website provides online

access to five manuals.
38
Australian patients
 Patients are becoming better informed and expect medical staff to

inform them of treatment options, risks and benefits, and tests required.
 Consumer organisations exist which challenge health providers and
policy makers.
 No “typical” patient in multicultural Australia.
 Free interpreter services are available to assist patients who have
difficulty understanding English.
 Using an interpreter, rather than family or friends, helps to maintain
patient privacy.
 The Health Translations Directory is particularly useful for health
practitioners working with culturally and linguistically diverse
communities to find reliable translated health information.
39
Cultural awareness
 Australians come from many cultural backgrounds so medical

staff should be mindful of the range of values and beliefs that may
be held by patients.
 Medical practitioners should be mindful of their own beliefs and
values and be aware that these may potentially conflict with those
of their patient.
 Be aware of potentially sensitive areas such as
 termination of pregnancy
 process of dying
 substance abuse
 Codes of Conduct exist which guide medical practitioners to
manage patient care appropriately. This may include referring the
patient to a colleague.
40
Cultural awareness training
 Cultural training helps participants to understand Aboriginal

culture and history and develop awareness of the key issues
facing Aboriginal people.
 All WA Health employees are required to undertake the on-
line cultural awareness training module within the first three
months of their employment.
 Some WACHS regions conduct Aboriginal cultural training
specific to local population groups. Sessions may be
presented by representatives from the local Aboriginal
community.
 External agencies also provide training modules.
41
Communication
 Cultural differences can impact significantly on the

relationship between the patient and the doctor.
 Be polite, honest and direct, and confirm with the patient that
they fully understand your proposed actions.
 Good communication is essential to good medical practice
 assume difference until similarity is proven
 check your assumptions
 delay judgement until you have had time to observe
 remain sensitive to the other person’s viewpoint
• Australian College of Emergency Medicine
Indigenous Health and Cultural Competency program
42
Professional conduct of doctors
 Doctors in Australia are expected to protect and promote the health of

communities and individuals.
 The Medical Board of Australia has documents to guide medical
practitioners working in Australia
 Good Medical Practice
 Medical - Guidelines for Mandatory Notifications
 Sexual Boundaries: Guidelines for doctors
 The AMA Code of Ethics outlines core principles to guide doctors in
their professional conduct
 clinical research and teaching
 respect for patients
 standards of care
 doctor’s role in society
 professional conduct  the dying patient and transplantation
 advertising  professional independence
43
Working with children
 Children are among the most vulnerable members of society

and WA Health has a duty of care to provide a safe
environment.
 WA Health employees whose duties potentially involve contact
with children, must undertake a Working with Children Check.
 Specific categories defined in Working with Children (Criminal
Record Checking) Act 2004:
 a public or private hospital ward in which children are ordinarily
patients
 a community child health service
 a counselling or other support service.
44
Mandatory reporting of child abuse
 Under the Children and Community Services Act 2004,

and the Children and Community Services Amendment
(Reporting Sexual Abuse of Children) Act 2008 doctors,
midwives, nurses, teachers and police officers are listed
as mandatory reporters of child sexual abuse.
 Medical practitioners must make a report if they form a
reasonable belief that child abuse has or is occurring.
 WA Health employees should follow the Guidelines for
Protecting Children 2015.
45
Child neglect
 Suspected cases of child neglect can be referred to the

Child Protection Unit (CPU), a specialised unit within PMH
 Cases that would be appropriate for referral include:
 Injuries or have had previous injuries that may be inflicted injury
e.g. fractures, bruises, lacerations, burns
 Non-organic failure to thrive
 A concern of sexual abuse, neglect and induced/fabricated illness
 A previous unexplained infant death in the family
 Believed to be at risk due to the mental or physical ill health of the
parents
 Believed to be at risk due to domestic violence, alcohol abuse or
drug use
46
Australian law
 Everyone in Australia is expected to obey all Australian laws.

 Crime is defined as any behaviour that is against the law and
may result in punishment
 Domestic or family violence
 Sexual assault: in WA the legal age of consent is 16 years of age
for males and females
 Women have the same rights as men, and it is illegal to practice
female genital mutilation.
 The human rights of children are protected by law.
 There are many laws about having possession of and using
drugs.
 It is illegal to buy alcohol and tobacco if you are under 18 years of
age.
47
Registration of doctors in Australia
 Topics covered
 AHPRA and Medical Board of Australia
 Initial registration
 Health assessment and monitoring
 Guidelines and registration standards
 Australian Medical Council
 medical registration pathways
 Competent Authority
 Specialist pathway
 Standard pathway
 professional development
 professional organisations
48
AHPRA and Medical Board of Australia
 The Australian Health Practitioner Regulation Agency

(AHPRA) is responsible for registration and accreditation of
14 health professions across Australia.
 In WA, AHPRA's operations are governed by the Health
Practitioner Regulation National Law Act 2010, (National
Law).
 The Medical Board of Australia (MBA) is one of the Boards
supported by AHPRA.
 Every doctor practicing medicine in Australia must be registered
with the MBA.
 Registration categories include: general, provisional, limited,
specialist and non‐practicing.
49
Registration with the MBA
 IMGs applying for initial registration must show evidence that

they are eligible under one of the pathways:
 Competent Authority pathway
 Specialist pathway
 Standard pathway
 Must prove proficiency in the English language through
satisfactory completion of English assessment process.
 Primary qualifications must be verified through
the Electronic Portfolio of International Credentials (EPIC)
service.
 Revised registration standards from 1 July 2016.
50
Australian Medical Council
 The AMC is an independent national standards body for

medical education and training.
 The AMC conducts the assessment process for IMGs in the
Standard Pathway only, administering exams for IMGs to
ensure they meet the standard of knowledge, skills and
attitudes expected of Australian medical graduates following
internship.
 AMC oversees the workplace-based assessment program
(WBA) in WA and other states.
51
Competent Authority Pathway
 CA Pathway is intended for non-specialist IMGs, but is

available to specialists, including general practitioners.
 The current AMC-designated competent authorities are
 United Kingdom - General Medical Council
 Canada - Medical Council of Canada
 United States - Educational Commission for Foreign Medical
Graduates
 New Zealand - Medical Council of New Zealand
 Ireland - Medical Council of Ireland
 As of 1 July 2014, IMGs who are eligible may apply for
provisional registration via the Competent Authority Pathway
 Subject to MBA IMG supervision guidelines
52
Specialist Pathway
 This pathway is open to specialists who

 have overseas qualifications which are partially recognised by
an Australian medical specialist college
 seek to work as an Area of Need specialist
 wish to train in Australia for a limited period
 Primary qualifications must be internationally recognised and
verified through the online ECFMG’s EPIC.
 IMGs may be required to establish an AMC portfolio.
 As of 1 July 2014, IMGs apply directly to the specialist
medical college for the Specialist Pathway.
 The MBA makes the final decision on granting registration.
53
Standard Pathway
 Generally for non-specialist IMGs seeking general registration in

Australia and who do not qualify for the Competent Authority
Pathway.
 Subject to MBA IMG supervision guidelines
 These IMGs can progress to AMC Certificate and general
registration via AMC exams
 Part 1: Computer Adaptive Test Multiple Choice Questionnaire (CAT
MCQ)
 Part 2: Clinical Examination through an integrated, multi-station
multidisciplinary structured clinical assessment
OR
Workplace-based assessment (limited availability)
54
Workplace-based assessment
(Standard pathway)
 Program of clinical assessment in everyday clinical practice setting

to assess at end of PGY1 (intern) level
 integration of clinical knowledge and skills
 safe and effective clinical judgement
 managing patients and working in multidisciplinary teams
 WBA is implemented in seven jursidictions, overseen by members
of the AMC Board of Examiners to ensure consistency in format
and standards.
 Duration of the WA program is
12 months. IMGs enrolled in the
program complete the supervised
practice requirement during the
assessment program.
55
Professional development and education
 Diversity of clinical practice in Australia means medical practitioners

must undertake life-long learning to ensure they maintain their
clinical knowledge.
 Continuing Professional Development (CPD) is mandatory to
maintain medical registration.
 Specialist medical colleges provide CPD activities to members and
many professional organisations offer training workshops and
education sessions.
 Seeking advice is part of the learning process. Most colleagues will
have faced similar situations in their work experience and be happy
to advise you.
 These interactions with colleagues will help you to build a strong
collegiate network.
56
Professional organisations
 Specialist medical colleges

http://www.cpmc.edu.au
 Australian Doctors Health Network provides information on

common problems, health, specific groups and resources for
doctors and medical students in Australia and New Zealand.
http://www.adhn.org.au/contact/western-australia
Australian Medical Association (AMA) a political and industrial
association representing doctors in public and private practice,
aims to maintain professional and economic wellbeing of its
members.
www.amawa.com.au
57
Professional organisations
Additional contacts in section 5.6
 Australasian Medical Writers Association (AMWA) peak body for

promoting excellence in health and medical communications in
Australia and New Zealand through conferences, continuing
education, networking and mentoring
http://www.medicalwriters.org/
 Australian Society for Medical Research (ASMR) peak professional
society representing Australian health and medical research
http://www.asmr.org.au/
 Rural Health West the rural workforce agency in WA, works
collaboratively with other organisations to develop a high-quality,
sustainable health workforce in rural WA.
www.ruralhealthwest.com.au
58
Support organisations
Additional contacts in section 5.6
 Bush Support Services: 24 hour telephone counselling service for ALL

remote health workers/service providers and their families
1800 805 391
 Doctors Health Advisory Service: confidential 24-hour telephone support
service in times of personal crisis.
(08) 9321 3098
 DoctorConnect: website for IMGs providing information about Australian
society and the health system.
www.doctorconnect.gov.au/
 Rural Doctors Association of Australia (RDAA): a national body
representing the interests of rural medical practitioners around Australia
and comprises the RDAs of each State and Territory.
http://www.rdaa.com.au/
59
Working in Western Australia
(Manual section 6)
 Topics covered
 working in hospitals
 occupational safety and health
 imaging and pathology
 prescribing and schedule 8
 medical credentialing
 infection control
 taxation and insurance
 medico-legal issues
 deaths in hospital
 working in general practice
60
Working in hospitals
 WA hospitals operate with multidisciplinary teams comprising doctors,

nurses and allied health staff.
 Hospital employment provides valuable clinical experience to enhance
knowledge and technical skills.
 Interns and resident medical officers (RMOs) undertake supervised
rotations across a range of clinical settings.
 Many hospitals have regular education sessions which support career
development of IMGs and Australian-trained graduates.
 All new medical staff must be provided with an orientation to the hospital
which includes
 hospital layout, services and how to access these
 emergency procedures and escalation protocols
 online mandatory training modules via hospital intranet site
61
(Medical education pathway and position titles)
62
(Common medical position titles)
63
Hospital doctors: role, training, supervision
 RMOs play a key role in day-to-day management of patients

whilst enhancing knowledge and clinical skills.
 Liaise with other medical staff, nurses and allied health staff and
play a central role in patient management.
 Ensure patient records are maintained, tests are ordered, results
reviewed and discharge plans created.
 Participate in education sessions and are regularly assessed by
their supervising clinician during the clinical placement.
 The Australian Junior Doctor Curriculum Framework can guide
you to set learning goals with your supervisor to the standard of
clinical competence expected of Australian graduates.
http://curriculum.cpmec.org.au
64
Communication and handover
 Communication among members of the multidisciplinary team is

essential for good patient management.
 Includes discussions with nursing and allied health staff and
doctors who may be covering your patients.
 WA Health uses the ISOBAR handover protocol
I - introduce self (name, role, contact number) and patient (name, birth date,
gender)
S - explain situation: presentation, diagnosis, principle problems, reason for
making contact
O - most recent observations, drips and drains
B - background to the patient: medications, allergies, test results, social
A - agree a plan: what is the urgency, who does what, when
R - read-back the situation: clarify shared understanding, clear on roles/tasks
65
66
Handover prompt – points to consider
(WACHS)
67
Discharge planning
 Clear and appropriate communication with community-based

health practitioners is essential to support the patient following
discharge. GPs, allied health etc.
 Commence discharge planning early to ensure timely
discharge, particularly for patients living in rural WA.
 Consider the patient’s personal status and support network and
their access to rehabilitation and long-term care.
 Discharge planning should include
 communication with GPs
 transport arrangements
 follow-up appointments
 pharmacy requirements
68
Discharge planning
 Discharge summaries must be completed for all patients.

 Prior to discharge, if the patient consents, written
communication should be prepared for the patient’s GP to
advise of follow-up treatment and medications required.
 Arranging follow-up by the following services should be
considered when preparing to discharge the patient:
 ACAT geriatric assessment
 HACC assessment
 Silver Chain services (nursing and home help)
 Allied health services (physio and occupational therapy, social
work, speech and hearing etc.)
 Outpatient appointments at hospital clinics
69
Discharge planning
 The mandatory Admission

, Readmission, Discharge and Transfer Policy for WA Health Services was
introduced on 28 June 2017, providing a framework, containing detailed
rules and criteria to enable accurate and timely information about the care
we provide, ensuring that our health services are adequately funded for the
services they provide.
 Further information: Information Management Policy Framework
70
71
72
Hospital emergency departments
 Emergency departments in public hospitals provide free 24 hour 7 day

emergency care.
 Patients are always seen in order of clinical urgency according to

triage score
 triage 1 = most urgent
 triage 5 = least urgent
 The Australian Government Department of Health has developed an

Emergency Triage Education Kit.
 The Emergency Telehealth Service uses telehealth technology to

provide specialist emergency medicine support to clinical staff treating
acute patients in WACHS.
73
Hospital support for doctors
 Junior doctors who experience professional or personal

difficulties can access a number of support options
 Clinical supervisor
 Director of Clinical Training (DCT)
 Medical administration staff
 Medical Education Officers (MEOs)
 Director of Medical Services (DMS)
 Director Postgraduate Medical Education (DPGME)
 Medical Officer representative
 Postgraduate Medical Council of WA (PMCWA)
74
Rosters and salary
 Junior doctors work a mix of day, night and weekends.

 Interns and RMOs at RPH, SCGH, FH rotate through five terms of
approximately 10 weeks duration.
 Rotations may be in outer metropolitan and rural sites.
 RMOs at KEMH undertake rotations of between 8-9 weeks across 6
terms
 RMOs at PMH/PCH undertake 12-14 week rotations across 4 terms
 Employment conditions for junior doctors in WA public hospitals are
set out in industrial agreements signed between the AMA (WA) and
Minister for Health.
 Copies can be obtained from the AMA (WA) or your employing hospital.
75
Occupational safety and health
 WA Health has comprehensive OSH programs in place at all

sites providing an integrated safety and health and injury
management service.
 It is a WA Health requirement that all clinical incidents are
notified using the Datix Clinical Incident Management System
(CIMS).
 The Patient Safety and Clinical Quality Division has
developed a CIMS Toolkit and eLearning resources.
 The OSH Officer for this hospital is:
 <name> <contact number>
76
77
Imaging and pathology services
 Imaging and pathology investigations should be ordered in terms

of how they influence medical decision making.
 Request forms should be written clearly specifying the range of
investigations to be performed. Additional reports can be ordered
(e.g. copy to the GP).
 Specimens must be fully labelled including time and date of
collection, type of specimen and site.
 Indicate clearly if investigations are urgent and notify the service
in advance to facilitate processing. Contacts in this hospital are
 Pathology: <contact number> <name>
 Radiology: <contact number> <name>
78
79
80
Prescribing medications
 National Medicines Policy encourages the use of generic medicines to

reduce pressure on the PBS.
 Medications are generally referred to by their brand/generic name rather
than active ingredients. These may be very different to the names you are
used to.
 Resources to assist you to identify Australian brand and generic names are
provided in the Orientation Manual.
 Specific protocols and forms exist for prescribing drugs of dependence
(Schedule 8 drugs).
 When preparing to discharge a patient ensure they know to consult their GP
for community-dispensed prescriptions for any ongoing medications.
 The WA Medication Safety Group provides consultative advice on safe use
and practices related to medication management for the patient’s hospital
admission and transition between primary and secondary care providers.
81
Schedule 8 medications
 Medicines and poisons are classified based on level of

toxicity and their use.
 Schedule 8 / Controlled Drugs require restriction to reduce
abuse, misuse and physical or psychological dependence.
 The Medicines and Poisons Regulation Branch has
produced:
 The Schedule 8 Medicines Prescribing Code
 Legal requirements for the prescribing of schedule 8
medicines under the Medicines and Poisons Act 2014 and
the Poisons Regulations 1965.
82
Medical credentialling and scope of practice
 Medical practitioners providing hospital services are

credentialled to ensure they hold suitable qualifications.
 Scope of practice is set based on these credentials and
defines the clinical practice that a medical practitioner is
permitted to conduct at a particular health care facility.
 Doctors must show evidence that they are maintaining their
skills to retain their credentialled scope of practice.
Further information: The Policy for Credentialling

and Scope of Clinical Practice for Medical Practitioners (2nd Edi
tion)
83
Infection control
 Infection prevention and control is covered in a

mandatory training module for all WA Health staff.
 Be aware of hand washing; wearing gloves; handling sharp
implements and exposure to blood and body fluids.
 All WA hospitals have protocols to be followed in the case of
exposure to risk of infectious diseases. Medical practitioners should:
 Adhere to infection control guidelines and protocols
 Have the recommended immunisations early in their career
 Be aware of and follow post-exposure protocols
 Doctors treating a health care worker for exposure to an infectious
disease should consider whether that person’s practise should be
reviewed. Seek advice if unsure.
84
Taxation and insurance
 A tax file number is issued by the Australian Taxation Office (ATO)

and is provided to your employer to withhold the minimum required
tax. Apply directly to the ATO for a tax file number: www.ato.gov.au
 Salary packaging uses pre-tax income to purchase benefits thereby
reducing the amount of tax paid. Access to salary packaging
depends on employment arrangements.
 Superannuation is money set aside to provide for your retirement.
Employers must contribute 9.5% of salary payments and employees
can make pre-tax contributions.
 To maintain registration, medical practitioners must have professional
indemnity insurance for all areas of practise.
 Further information: professional indemnity insurance registration standard.
85
Medico-legal issues
 In both public and private practice, all medical treatment must be

documented in the patient’s medical record. Information should
include:
 patient identification, presenting problem and medical history
 physical exam, diagnostic and treatment orders
 observations, findings, diagnosis and discharge summary.
 Except under specific legal requirements, medical practitioners must
keep all patient information confidential.
 While working for WA Health, requests from lawyers for legal reports
or patients wishing to make a complaint should be referred to
Medical Administration.
 Minimise potential risks through good communication and accurate
patient records.
86
Notifiable conditions
 Medical Practitioners practising in WA are legally required to

report a number of diseases and medical conditions.
 The Legal Policy Framework specifies the requirements that
all hospitals must comply with in order to ensure an effective
and consistent legal approach across the WA health system.
 This information is vital to assist the Department of Health to
monitor medical events and develop appropriate health
responses and policies.
 The Communicable Disease Control Directorate deals with
reporting of a number of notifiable conditions which are listed
and detailed on the WA Health website.
87
The patient
 Patients in Australian public hospitals are entitled to expect

and receive high quality services.
 The Public Patient Hospital Charter sets out public patient
rights and obligations.
 Patient experience has been endorsed by the Director
General as an important priority for WA.
 A great patient experience identifies principles essential for
good customer service in healthcare.
 You Matter Guideline was developed to support WA health
services in their engagement with consumers, carers,
communities and clinicians to improve health services.
88
89
Patient consent
 You must obtain consent from the patient before any surgical or
invasive procedure.
 Doctors must adequately explain all proposed treatment,
highlighting benefits, risks and consequence of no treatment.
 In many instances children will require parental consent.
 In some circumstances a child may be considered a “mature
minor” and can grant their own consent.
 The scope of consent for medical treatment varies based on the
level of responsibility held by appointed guardians.
 Use a professional interpreter to gain consent from patients with
limited English, particularly of medical terminology.
 To protect patient confidentiality avoid using family or friends.
90
91
92
Medico-legal issues
Advanced Health Directive

 “living will” that gives direction on health matters and comes into
force if patient is unable to make reasonable judgments about
their treatment later on.
Guardianship
 Protects the rights of adults with decision-making disabilities
which may be the result of intellectual disability, mental illness,
acquired brain injury or dementia.
Freedom of information
 Patients can obtain access to their medical records by
submitting a written request to the hospital.
93
Sexual harassment and bullying
 WA law makes it unlawful to discriminate against a person on the

basis of such things as
 gender, marital status, race, pregnancy, sexual orientation, family
responsibility and status, impairment and age, religious or political
conviction.
 WA Health has policies in place to uphold this law and to prevent
bullying, violence and aggression in the workplace.
 Equal Opportunity Act 1984 (WA)
 WA Health Substantive Equality Policy OD 0634/15.
 Occupational Safety & Health Act 1984 (WA)
 WA Health Preventing and Responding to Workplace Bullying Policy
OD 0437/13.
94
Deaths in hospital
 All Health Services have protocols for certifying deaths.

 Medical practitioners should know how to access the necessary
forms and information for this process.
http://www.health.wa.gov.au/CircularsNew/circular.cfm?Circ_ID=13018
 Numerous circumstances have been identified which, if they
occur, result in a death being considered “reportable”.
 Those aware of a “reportable death” are legally obliged to report
this to the Coroner or the Police.
 If there is any doubt, the Coroner’s advice must be sought.
 An inquest is a formal hearing into a “reportable death” in WA.
 The State Coroner, the Deputy Coroner and all magistrates can
conduct coronial investigations.
95
Organ transplantation
 In Australia, State and Territory health services provide solid organ

transplant services for heart, lung, kidney, liver and pancreas
transplantation.
 Australia has an “opting in” system of organ and tissue donation.
 In WA the legislation dealing with the donation of organs and tissue
after death is defined in the Human Tissue and Transplant Act 1982
(Amended 1997).
 The Australian Organ and Tissue Donation and Transplantation
Authority and DonateLife work in partnership with state and territory
governments to coordinate all organ and tissue donor activities.
 Professional Education Package
 Donor Coordinators at SCGH are available 24 hours on 08 9346
3333
96
Working in general practice
 IMGs who first gained general registration after July 1997 have
restricted access to a Medicare provider number for 10 years
(known as the 10 year moratorium).
 To gain a provider number exemption must be sought under section
19AB of the Health Insurance Act 1973.
 IMGs can access provider and prescriber numbers from the
Australian Government if they work in a District of Workforce
Shortage.
 Further information on working as a general practitioner:
Doctorconnect
97
Rural general practice in WA
 Working as a GP in rural WA can be immensely challenging and

rewarding.
 Many GPs work in group practice and enjoy the support of their
colleagues. Some GPs work as solo practitioners and rely on the support
of locum doctors to take time away from work.
 If granted admitting rights as a Visiting Medical Practitioner, GPs can treat
patients at the local hospital but must abide by all hospital policies and
procedures.
 Depending on their scope of practice and the hospital’s facilities, GPs may
provide emergency services, as well as surgical, anaesthetic and obstetric
services.
 Services provided by the VMP are contracted by WACHS and the
conditions and rates of pay are set out in the Medical Service Agreement.
98
Support for country doctors
 WACHS salaried doctors and rural GPs can access clinical

advice from doctors in metropolitan hospitals.
 Perth-based medical specialists may provide services to country
hospitals through the visiting specialists program.
 Country doctors should be familiar with the schedule of visiting
specialists and know how to access clinical support from Perth-
based colleagues.
 Many country hospitals have well-established referral patterns
which new doctors should become familiar with.
 WACHS has established a telecommunications network and a
Telehealth program to provide specialist clinical support to
remote locations.
99
Living in Western Australia
 The Orientation Manual provides general information on the

following topics:
 visa requirements
 what to do soon after arrival
 housing and utilities
 private health insurance
 education
 employment for partners
 childcare
 emergency services
 transport
 information for seniors
100
Other useful information
(Manual Appendix 1 and 2)
 The Appendices in the orientation manual provide the

following information
 Medication terminology used in WA
 Dose frequency and timing
 Route of administration
 Unit of measure
 Dose forms (including latin terms)
 Dangerous abbreviations
 Health industry acronyms
101
Questions?
102

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Living and working in WA

The Medial Board of Australia introduced international medical

• Orientation to the Australian healthcare system

Further information: http://

Australia is a Federation of 6 states

There are 3 time zones in Australia:

The Australian healthcare system is complex and comprises a

State Government Federal Government

Medicare PBS Other programs

Public hospital Private patient –

 Supports those who serve or have served in Australian

The White Card Repatriation Health Card - For Specific Conditions

The Orange Card Repatriation Pharmaceutical Benefits Card

Other DVA eligibilities

• The Repatriation Pharmaceuticals Benefit Scheme (RPBS) provides a wide range of

• The Veterans’ Pharmaceutical Reimbursement Scheme (VPRS) is an annual reimbursement for

How is Medicare funded?

Issued to all people eligible to access health services under

The Yellow Medicare Card

The Blue Medicare Card

 Eligible patients can access free public hospital services and

 Patients can opt to be admitted as a private patient in a public

 The Australian Government Department of Human Services

 The online Medicare Benefits Schedule - MBS Online -

 Subsidy scheme for prescription medicines. Eligible people

 Unrestricted: can be prescribed without PBS restrictions on

 General category: pay the cost of dispensed medicines up to a

PBS online learning

To provide services funded by Medicare, doctors must apply for

Medicare provider number

PBS prescriber number

• Works in tandem with Medicare to reduce the demand on

The public health system, known as WA Health, consists of:

The Department of Health is led by the Director General and provides

The HSPs are governed by Health Support Boards.

Each HSP is responsible for their local areas and communities.

WA public HSPs include:

 Metropolitan Health Service

 WA Country Health Service (WACHS)

Child and Adolescent Health Service

North Metropolitan Health Service

South Metropolitan Health Service

East Metropolitan Health Service

PathWest Laboratory Medicine WA (PathWest)

 Region of over 2.5 million km2

Seven health regions

 Health@Home supports patients in their home to retain

 Dental Health Service provides emergency and general dental

 Public Health Division focuses on prevention and early detection

 Mental Health services are overseen by the Mental Health Unit.

 Private health services include a network of private hospitals and

 Aged Care Assessment Team (ACAT): teams of health

 Home and Community Care (HACC): provides basic support

 Hospital in the Home (HITH): provides hospital care in the

 Silver Chain: provides a range of clinical and health care services

 Aboriginal Health Council of WA (AHCWA): the peak body for the

 Poisons Information Centre (WAPIC): a specialised unit that

 Newborn Emergency Transport Service (NETS): coordinates

 Royal Flying Doctor Service (RFDS): is a not-for-profit service