Many countries have experienced long term growth in healthcare demand which has outstripped workforce growth. International medical graduates significantly contribute to the Australian workforce and health communities across diverse settings. Making up over
30 percent of the medical workforce and over 50 percent of the general practice workforce - they are the mainstay of rural and remote health communities and under served metropolitan communities.
The problem Australia faces
Australia, along with other OECD countries, experience barriers to international medical graduate assessment with individual and system level impacts. Pathways for international
medical graduates are complex, at times bureaucratic, time consuming, uncertain, expensive and stressful.The perception of a difficult pathway to medical practice in Australia leads international medical graduates to go elsewhere to the likes of New
Zealand or Canada, where assessment systems, registration and migration may be perceived as less burdensome. The workforce issue requires urgent attention, and the international medical graduate journey needs to be simplified.
A shared space: international medical graduate pathways and assessment
The Australian Medical Council (AMC) is a national standards body for medical education,
training and assessment. Its purpose is to ensure that the standards of education, training and assessment of the medical profession promote and protect the health of the Australian community. The AMC sets the standard for and manages the national assessment for international medical graduates who are seeking to establish eligibility for general registration. It contributed to the development of all the current Australian assessment pathways for international medical graduates, and additionally it undertakes research and analysis to support the review and improvement of assessment pathways so they remain valid, reliable, fair and efficient.
In Australia, international medical graduate assessment and pathways are a shared space with many stakeholders such as the Commonwealth Government, Australian Medical Council, Ahpra, Medical Board of Australia, Prevocational Councils, Specialist Medical Colleges, bridging course providers, recruitment agencies and most importantly, international medical graduates. So, they have a stake in international medical graduate pathways and the identification of opportunities for improvement. This means much of the activity to progress improvement and evaluate success needs to be undertaken in partnership.
Australian Medical Council (AMC), Clearing The Way Project
The AMC is aligning its assessment innovation to workforce strategy in the International
Medical Graduate Experiences and Performance Project. It maps to both the National Medical Workforce Strategy and the Independent Review of Overseas Health Practitioner Regulatory Settings, led by Robyn Kruk, AO. The project seeks to approach international medical graduate recruitment through a more generous, sensitive and supportive process.
Our methods
Our work and deliverables are evidencebased. They draw on data from a survey with over 4000 international medical graduate respondents. Focus groups with health services and international medical graduates were also conducted with in-depth interviews and sought insights from our cross-sectorial project advisory group.
Common challenges faced by international medical graduates:
Preparation for immigration and work in Australia involves cultural adjustments,
a significant financial burden, and the learning of new skills.
Document management can be complex and even require international medical graduates to return to their country of training. This can be difficult for certain groups like refugees.
Recency of practice issues can emerge for international medical graduates as it can take significant time to pass assessments. This can have impacts on their registration and opportunity to work as a medical practitioner.
Access to supervision can be difficult, this can impact progression in passing assessments and securing employment.
Discrimination and exploitation is reported by many international medical graduates. This effects their wellbeing, sense of belonging, identity and financial position.
International medical graduates can be subject to a 10 year moratorium to work in rural areas. This can impact family life i.e. children’s schooling and partner employment - up to 50 percent of survey respondents stated they had chosen to live separately for significant periods.
Aboriginal and Torres Strait Islander patients and communities many international medical graduates reported they are unfamiliar with the history and specific needs of Aboriginal and/or Torres Strait Islander patients and communities. Some international medical graduates reported they immigrated from colonised countries so felt that they did not need to learn new skills related to cultural safety. Others felt they did not need to learn about the specific needs of Aboriginal and/or Torres Strait Islander communities because they treated all their patients with respect. Feedback gathered included that some international medical graduates need to gain tailored training to improve their understanding of the needs of Aboriginal and/or Torres Strait Islander communities and opportunities to meet and work with Aboriginal and/or Torres Strait Islander health professionals.
Continuous improvement challenges were reported by international medical graduates at both an individual, and system level. Accessing relevant courses and learning opportunities can be particularly challenging for those located in rural areas with financial and time impacts reported as common barriers to ongoing learning. Equally, ‘learning fatigue’ is reported given the rigor of undertaking years of medical education in their home country followed by years taken to navigate assessment requirements to enter the Australian health system.
The purpose of this work
The health system is fragmented with multiple agencies responsible for international medical graduates – partnerships are needed to action change.
International medical graduates have strong lived experience which can guide future improvements based on feedback about challenges and enablers.
Policy leaders can take shared responsibility to recognise international medical graduate journeys and experiences.
International medical graduates experiences and journeys are various so enablers need to be customised to meet individual and system needs.
Project approach
The report, "Clearing The Way: High Impact Initiatives to Support International Medical Graduates," sets out to present a series of prioritised actions aimed at enhancing the efficiency, effectiveness, and sustainability of assessment pathways for international medical graduates.
The goal is to improve user experience while maintaining high standards to ensure that only practitioners who are properly trained, qualified, and committed to ethical practice are registered. These initiatives are grouped into five themes:
Download the full Clearing The Way report here.
The AMC has also prioritised initiatives by degree of collaboration required. This includes activities within the remit of the AMC to be completed relatively independently within AMC budget (Lead); cross-sectorial activities for which the AMC would seek to partner and joint funding (Partner); and activity which other sectors would lead and fund which the AMC would support (Support).
Other deliverables developed as part of the International Medical Graduate Assessment
Experiences and Performance project over the course of 2023/24 included:
Personas — which reflect the heterogeneity of international medical graduates — to better understand the characteristics and pain points for international medical graduates and what support they need. Through evidence-based story telling we aimed to put a human face to the challenges and possible solutions which would help lead strategy development at the AMC and more broadly in working with partners.
Journey maps — which aim to capture the key milestones of the journeys of these graduates through their lens, involving supervisors, health services, policy makers, medical educationalists and system leaders. We have developed current and future state maps which set out challenges and solutions to guide system change.
A Project Advisory Group is spearheading this initiative, drawing on a diverse range of stakeholders involved in the assessment of international medical graduates. This group includes international medical graduates, health consumers and community members, the Council of Presidents of Medical Colleges, Postgraduate Medical Education Councils, executive staff from health services (spanning general practice in metropolitan, outer metropolitan, rural, and regional areas), the Medical Board of Australia (MBA), the Australian Health Practitioner Regulation Agency (Ahpra), the Australian Medical Association (AMA), AMC committees and processes, Aboriginal and Torres Strait Islander representatives, government agencies, examiners, supervisors, Workplace-Based Assessment Providers, and bridging course providers.
The international medical graduate experiences and performance project has the approval of the Monash University Human Research Ethics Committee, the project is planned to conclude in early 2025. It’s goal is to educate and inform people of the unique skills and experiences of international medical graduates, and the need to further improve assessment processes to facilitate their integration, and strengthen support networks to enhance cultural adaptation.
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