The 4 Stages of Medical Education in Australia and New Zealand

The medical education systems of Australia and New Zealand were originally modelled on those of the United Kingdom but as time went on they evolved into a more structured format and developed their own unique features whilst maintaining their reputation for thorough and premier quality training and education at both undergraduate and postgraduate levels. Indeed Australian and New Zealand medical qualifications are prized by leading healthcare employers across the world and accepted by most medical regulatory authorities.

Australian and New Zealand specialist qualifications are recognised as equivalent to Canadian qualifications by the Royal College of Physicians and Surgeons of Canada and are ranked Tier 1 by the medical regulatory authorities of the United Arab Emirates, Saudi Arabia, Qatar, Kuwait, Oman and Bahrain opening opportunities for specialists and family physicians to work in these countries.

The quality of the specialist training programs and their ease of access for international medical graduates (IMGs) renders Australia and New Zealand premier destinations for junior doctors who can meet the eligibility criteria for medical registration and visas. UK and Irish medical graduates who have completed internship (PGY1) and obtained full general registration with the General Medical Council or Irish Medical Council are eligible to work in Australia and New Zealand. However USA and Canadian graduates along with graduates of other medical schools worldwide have pathways to eligibility.

Medical education in Australia and New Zealand can be divided into four distinct stages, each of which involves the experience and expertise of different organisations. In some cases these organisations cover both Australia and New Zealand, while in other cases separate entities operate in each country.

Stage 1: Medical Degree

The first stage of training is the basic medical degree, the Bachelor of Medicine and Surgery (MBBS) and is the responsibility of the university medical schools. Entry to these may be directly from secondary school (direct entry) or by way of completing an earlier undergraduate degree in a different discipline (graduate entry). University medical school courses are accredited by the Australian Medical Council (AMC) or Medical Council of New Zealand (MCNZ) and vary in length from four to six years.

Universities offering degrees in medicine with direct entry programs are: 

• Bond University (Queensland)
• James Cook University (Queensland)
• Monash University (Victoria)
• University of Adelaide (South Australia)
• University of Auckland (New Zealand)
• University of Melbourne (Victoria)
• University of New South Wales (New South Wales) 
• University of Newcastle and University of New England (New South Wales)
• University of Western Australia (Western Australia)
• University of Otago (New Zealand) 
• University of Tasmania (Tasmania)
• University of Western Sydney (New South Wales)

Universities offering degrees in medicine with graduate entry programs are:

• Flinders University (South Australia)
• Deakin University (Victoria) 
• Griffith University (Queensland)
• Australian National University (Australian Capital Territory)
• University of Melbourne (Victoria) 
• University of Notre Dame Australia, Sydney (New South Wales)
• University of Notre Dame, Australia (Western Australia)
• University of Queensland (Queensland)
• University of Sydney (New South Wales) 
• University of Western Australia (Western Australia) 
• University of Wollongong (New South Wales) 
• University of Waikato (New Zealand) - from 2027

Stage 2: Pre- Vocational Medical Training

The second, or pre-vocational, stage of training is jurisdictionally based and is overseen, in the case of the Australian States and Territories, by Postgraduate Medical Councils. In New Zealand it is the responsibility of the Education Committee of the Medical Council of New Zealand.

Pre- vocational training is equivalent to foundation years 1 and 2 in the UK and to internship in the USA. It commences at postgraduate year 1 (PGY1) and continues for a minimum of two years, although some specialties, such as emergency medicine, require a 3 year pre-vocational training period. During this time, resident medical officers (RMOs) rotate through a variety of medical and surgical specialties gaining broad general experience and gradually increasing levels of responsibility in preparation for entering into vocational training programs of their choice.

Stage 3: Vocational Medical Training

The third stage of medical training is the postgraduate vocational or specialist training and is the responsibility of the specialist medical colleges. These span State and Territory borders in Australia, and in some cases cover both Australia and New Zealand. Some of these colleges, including the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians offer training within a number of specialties. 

The AMC and/or MCNZ accredit these colleges and determine what specialties and qualifications they may offer medical graduates. The specialties recognised by the AMC and by the MCNZ are listed on their respective websites (www.amc.org.au and  www.mcnz.org.nz ). The specialist medical colleges are:

• Australasian College for Emergency Medicine (ACEM) www.acem.org.au
• Australasian College of Dermatologists (ACD) www.dermcoll.asn.au
• Australasian College of Sports Physicians (ACSP) www.acsp.org.au
• Australian and New Zealand College of Anaesthetists (ANZCA) www.anzca.edu.au
• Australian College of Rural and Remote Medicine (ACRRM) www.acrrm.org.au
• College of Intensive Care Medicine of Australia and New Zealand (CICM) www.cicm.org.au
• Royal Australasian College of Dental Surgeons (RACDS) www.racds.org
• Royal Australasian College of Medical Administrators (RACMA) www.racma.edu.au
• Royal Australasian College of Physicians (RACP) www.racp.edu.au
• Royal Australasian College of Surgeons (RACS) www.surgeons.org
• Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) www.ranzcog.edu.au
• Royal Australian and New Zealand College of Ophthalmologists (RANZCO) www.ranzco.edu.au
• Royal Australian and new Zealand College of Psychiatrists (RANZCP) www.ranzcp.org
• Royal Australian College of General Practitioners (RACGP) www.racgp.org.au
• Royal College of Pathologists of Australasia (RCPA) www.rcpa.edu.au
• The Royal Australian and New Zealand College of Radiologists (RANZCR) www.ranzcr.edu.au
• The Royal New Zealand College of General Practitioners (RNZCP) https://www.rnzcgp.org.nz/
  

Vocational training programs are structured and consist of basic and advanced training components. The duration of each component varies by speciality and details of programs in each speciality can be viewed on the appropriate College websites. The final final examination for Fellowship of the relevant medical college marks the end of the advanced training and grants the specialist qualification which permits independent medical practice in a consultant or specialist job. Some doctors undertake further fellowship training of 6 to 12 months in a subspecialist field.

Stage 4: Continuing Professional Development

The fourth and final stage of  medical training, is the only one that ends with the with the retirement of the practitioner. Continuing professional development is largely overseen by the specialist medical colleges, and requires practitioners to continually update their skills and ensure their knowledge is current. It also enables practitioners to widen or narrow their scope of practice. 

In Australia the specialist colleges’ continuing professional development courses are accredited by the AMC. In New Zealand, this is the responsibility of the Medical Council of New Zealand. In both countries medical practitioners must provide evidence of continuing professional development activities as a condition of their annual renewal of registration.

The Role of the Medical Councils

In both Australia and New Zealand medical education and training is overseen by independent standards bodies. The Australian Medical Council (AMC) assesses and, if appropriate, accredits the medical courses offered by Australian university medical schools. It also assesses and, where appropriate, accredits postgraduate medical specialist training programs and continuing professional development programs. The AMC collaborates with the Medical Council of New Zealand (MCNZ) in the assessment and accreditation of specialist training programs and continuing professional development programs that involve medical practitioners or trainees from both countries.

Specialist International Medical Graduates (IMGs)

IMGs with a specialist qualification may apply to the AMC or the MCNZ for assessment of their experience and skills. The appropriate medical college is then asked to determine their comparability to an Australian or New Zealand trained surgeon. If the assessed IMG is deemed comparable, he or she is supervised for a period of time prior to achieving a College Fellowship. Sometimes passing the College’s Fellowship examination may be required to demonstrate comparability to an Australasian Fellow.

If the IMG is assessed as not comparable, it is recommended that he or she apply for the relevant College’s education Training Program, just as an Australian or New Zealand medical graduate wishing to become a specialist does. This process of assessment acts as a safeguard, ensuring that IMGs seeking to work or train as specialists have achieved the same required standards as their Australian or New Zealand counterparts. 

Resident Medical Officer International Medical Graduates (IMGs)

IMGs who are recent medical graduates may apply for resident medical officer jobs in Australia and New Zealand if they meet the requirements for provisional general registration with the MCNZ or provisional or limited general registration with the AMC. Resident medical officer jobs are designated training or service jobs depending upon whether or not they have achieved accreditation for basic or advanced specialist training with the relevant medical college.

Service jobs are unaccredited for training but nevertheless provide useful clinical experience and training plus an opportunity to become familiar with the health care system whilst preparing for entry to vocational training programs. Training jobs are accredited for either basic or advanced training and time spent working in these jobs should count towards the requirements for fellowship. However some vocational programs have additional requirements and these should be confirmed with the appropriate medical college.