medical education in australia medical education in australia medical education in australia includes the educational activities involved in the initial and ongoing training of medical practitioners. in australia, medical education begins in medical school; upon graduation it is followed by a period of pre-vocational training including internship and residency; thereafter, enrolment into a specialist-vocational training program as a registrar eventually leads to fellowship qualification and recognition as a fully qualified specialist medical practitioner (that is a fully qualified general practitioner or consultant). medical education in australia is facilitated by medical schools and the medical specialty colleges, and is regulated by the australian medical council (amc) and australian health practitioner regulation agency (ahpra) of which includes the medical board of australia where medical practitioners are registered nationally. flowchart of medical career progression and pathways the australian medical education system is historically similar to that of the united kingdom, but in recent decades, has received influences from the united states and canada. in contrast to their north american counterparts, internship and residency in australia are pre-vocational terms intended for general clinical rotations so that the junior doctor can gain a broader clinical experience in various medical specialties prior to embarking on a specialist-vocational training program as a registrar, and upon successful completion, qualification as a fellow of a specialist medical college and therefore registration with ahpra as a specialist medical practitioner. in the united states, there are no pre-vocational terms, whereby specialty selection during internship ensures streamlined clinical rotations for that intended specialty pathway, and thereafter, enrolment and progression onto a residency program towards achieving specialist board certification; therefore, residency in the united states is equivalent to a registrarship in australia. 'board certified' attending physicians in the united states are equivalent to ahpra registered specialist medical practitioners. in australia and for the purposes of this article: consultants refer to specialist medical practitioners who practice in an ahpra recognised specialist field of medicine that is beyond the scope of and not general practice (or family medicine). general practitioners refer to specialist medical practitioners who practice in the ahpra recognised specialist field of general practice (or family medicine). in australia, general practitioners (gps) are essentially alike family physicians in the united states, who typically fufil the role of a primary care physician that is responsible for coordinating, assessing and managing general healthcare of their patients. gps typically refer patients to (or 'consult' with) consultants for an expert opinion and/or specialised treatment if required. the education and training requirements of a medical practitioner from starting medical school to completing specialist training typically takes between 9 years to 16 years (or more) assuming full-time study and work, and dependent on the specialty choice and satisfying in-training requirements. in australia, medical practitioners typically pursue a career pathway to become a specialist medical practitioner with the endpoint of working as either a general practitioner or consultant. there is a small subset of medical practitioners who decide not to formally complete registrarship nor attain fellowship qualification, and instead opt for a career as non-specialist hospitalist clinicians (also known as career hospital doctors or career medical officers); non-specialist hospitalists can typically work with a reasonable level of autonomy and independence dependent on their experience and skill, but nonetheless under the auspicies of a specialist medical practitioner. most of the specialist fellowship qualifications and medical school degrees awarded to australian-trained clinicians are internationally recognised. reciprocally, australia accepts most recognised university and specialty qualifications of international medical graduates from countries with well-established medical education programs and health systems; that is, pending verification of the person's identity (including visa and immigration requirements), qualifications, practice history and experience, english language competency, a probationary period of supervised practice, and any necessary examinations and assessments to abridge any gaps in knowledge to ensure clinicians are aligned to the current standard of medical practice in australia as dictated by the relevant medical specialty college, australian medical council and medical board of australia. medical school entry into medical school and its successful completion allows the graduate to become recognised as a medical practitioner (doctor) and commence their post-graduate pre-vocational training. the aim of medical school is to teach basic medical knowledge and clinical skills to prepare the prospective junior doctor for safe and competent practice upon commencement of their internship. it remains one of the most highly competitive university programs to apply for. nomenclature historically, australian medical schools have followed the united kingdom by conferring the degrees of bachelor of medicine and bachelor of surgery (mbbs) to its medical graduates, whilst reserving the degree of doctor of medicine (md) to be issued to those who have completed higher research studies or given honorarily to those who have contributed significantly to the medical professional community (analogous to the phd or honorary doctorates). while a significant proportion of australian medical schools as of the early 1990s have shifted from undergraduate to graduate entry programs (that is, enrolling students who have already completed a bachelor's degree in another field of study), medical schools continued to nevertheless award the mbbs as its standard medical degree regardless if it was an undergraduate or graduate entry program. some medical schools have moved to awarding md (or a combination of a bsc and md) instead of the mbbs to its medical graduates. however, given that the mbbs is categorised in the australian qualifications framework (aqf) as a level 7 bachelor's level degree it had the benefit of not mandating its students to partake in a research project, whilst the md is categorised a level 9 master's level degree it does require its students to formally produce a research project as part of their studies; that said, students in the mbbs program commonly did nevertheless still pursue research on an extra-curricular basis. regardless, both mbbs and md awarded at any australian medical school qualifies a person to be registered with the medical board as a medical practitioner and allow the graduate to be customarily addressed by their prefix title of 'doctor (dr.)'. it is also worthwhile to note that while the colloquialism of the term 'physician' in the united states is used to broadly refer to any type of medical practitioner, in australia and the united kingdom 'physician' typically refers to a medical practitioner who specialises in the field of internal medicine / general medicine or its sub-specialities; similarly, the 'surgeon' typically refers to a medical practitioner who specialists in a surgical specialty. in order to avoid confusion given the wide interpretation and availability of those who utilise the prefix of 'doctor (dr.)' in other professions, the medical board and relevant federal and state legislation has chosen to refer medical doctors formally as medical practitioners in australia. undergraduate entry medical schools have traditionally in australia followed the commonwealth and united kingdom by admitting students directly from secondary school (high school) matriculates. about half of the medical schools in australia remain undergraduate in their admission. applicants apply directly to the medical school and/or through the statewide facilitated university course placement program. applicants are typically assessed by a combination of their: australian tertiary admission rank (atar) score which is derived from the state's secondary school exit exam performance, university clinical aptitude test (ucat) score which assesses the suitability of the candidate for medicine based on psychometric, logic and reasoning assessment, curriculum vitae (cv) and references which should highlight any work experience and extra curricular achievements, such as musical or sporting, interview conducted by the respective university's medical school, which are typically multi-station and designed to further psycho-socially assess the candidate's suitability for medicine as well as assessing their merits undergraduate medical programs are typically 5 to 6 years in length following the traditional two-semester academic year (the exception to this is bond university which has a three-semester academic year which allows students to complete the course in 4.6 years). notwithstanding that there are some universities, while accepting the student as an undergraduate, typically require they complete a first degree in science (or something else) in addition to the medical degree that is to be completed concurrently. graduate entry about half of medical schools in australia have followed the united states and moved to post-graduate entry. applicants are varied from those of "pre-med" or health sciences related background and those from unrelated professions such as law or engineering. applicants are typically assessed by a combination of their: university grade point average (gpa) score in their recent degree(s) which is a reflection of their academic performance graduate australian medical school admissions test (gamsat) score which assesses scientific knowledge, problem solving and psychometric suitability curriculum vitae (cv) and references which should highlight the job experience and professional positions held, and any relevant skills or achievements interview conducted by the respective university's medical school, which are typically multi-station and designed to further psycho-socially assess the candidate's suitability to the medical profession graduate medical programs are typically 4 years in length. they do not follow a typical university academic year due to the volume of content and experience required to be learned. syllabus most medical schools follow a similar education program, which includes essentially two phases: pre-clinical (first 1–3 years) is typically classroom focused and theoretical in developing foundational medical knowledge of anatomy, pathophysiology, pharmacology, whilst gradually introducing the principles of patient care and basic clinical skills clinical (last 2–3 years) is typically based in the hospital or clinic where the student partakes in clinical placements in various specialties similar to an observership or clerkship where they learn from clinicians in order to further develop their clinical skills most learning is multi-modal and include traditional didactic learning through lectures, workshops, seminars, clinical simulation and tutorials, group-based tutorials such as cased-base-learning (cbl) or problem-based-learning (pbl), in addition to any hospital facilitated educational activities. research project(s) are mandatory in the master's level md programs and optional in the bachelor's level mbbs programs. this is in addition to encouraging students to be able to critically appraise literature and practice evidence based medicine. assessments commonly include a mixture of written (mcq, emq, short and long answer) and clinical exams (osce) at the end of each term or unit. it is important to note that unlike our counterparts in the united states where there is a standardised exam (usmle) across the country in order to become licensed to practise medicine, australian medical school exit exams are set by the individual medical school and serve as the qualifying exam to be eligible for medical board registration. successful completion of medical school allows the graduate to be registered provisionally with the medical board and proceed to applying for an internship. it is not until speciality training where there are standardised examinations held across the nation that is facilitated by respective medical speciality colleges. current australian medical schools and their basic qualifying medical degrees are listed below: universitycurrent degree(s)durationaqf levelentryprevious degree(s) university of adelaidebmedst/md6 years9undergraduatembbs australian national universitymchd4 years9graduatembbs bond universitybmedst/md4.7 years9undergraduatembbs deakin universitymd4 years9graduatebmbs flinders universitymd4 years9graduatebmbs griffith universitymd4 years9graduatembbs james cook universitymbbs6 years7undergraduate— university of melbournemd4 years9graduatebmedsc/mbbs monash universitybmedsc/md5 years9undergraduatembbs, mbbs(hons) monash universitybmedsc/md4 years9graduatembbs, mbbs(hons) university of newcastlebmedsc/md5 years9undergraduatebmed university of new englandbmedsc/md5 years9undergraduatebmed university of new south walesbmed/md6 years9undergraduatembbs university of notre dame australiamd4 years9graduatembbs university of queenslandmd4 years9graduatembbs university of sydneymd4 years9graduatembbs university of sydney bsc/md or ba/md 7 years 9 undergraduate/graduate (combined) ba(adv)(hons)/mbbs, bsc(adv)/mbbs, bmedsci/mbbs, bcomm/mbbs, becon/mbbs, bmusst/mbbs university of tasmaniabmedscmd5 years9undergraduate/graduate (combined)mbbs university of western australiamd4 years9graduatembbs western sydney universitybclinsci/md5 years9undergraduate mbbs charles sturt universitybclinsci/md5 years9undergraduate university of wollongongmd4 years9graduatembbs curtin universitymbbs5 years7undergraduate— macquarie universitymd4 years9graduate— internship internship is a period of mandatory supervised general clinical experience. it allows medical graduates to consolidate and apply clinical knowledge and skills while taking increasing responsibility for the provision of safe, high quality patient care. diagnostic skills, communication skills, management skills, including therapeutic and procedural skills, and professionalism are developed under appropriate supervision. internship also informs career choices for many graduates by providing experience in different medical specialities including general practice, and providing a grounding for subsequent vocational (specialist) training. the medical board of australia has established the intern registration standard. it defines the supervised intern (provisional registration year) training requirements that must be completed in order for graduates of australian and new zealand medical programs accredited by the australian medical council and approved by the medical board of australia to be eligible for general registration.