National Framework for Prevocational Medical Training

Prevocational training in Australia has long needed reform.¹ Internship in postgraduate year 1 (PGY1) was variably accredited by state and territory medical registration boards and then prevocational medical councils (PMCs), which were established in the 1980s and 1990s. In 2013, the Australian Medical Council (AMC) introduced a national framework for medical internship on behalf of the Medical Board of Australia (MBA). This was enabled by a new national registration scheme.² Many, but not all, PMCs have also accredited postgraduate year 2 (PGY2) posts. The AMC began accrediting PMCs almost three decades after medical schools and after a decade of college accreditation.

The structure of Australian internship, with mandatory terms in medicine, surgery and emergency medical care, has not changed in decades, despite significant changes in medical practice and health care needs. Interns have increasingly been performing more administrative tasks to maintain hospital throughput with fewer opportunities to use or develop their clinical skills.³ PGY2 rosters have generally been designed to meet hospital workforce requirements rather than the needs of prevocational doctors. The United Kingdom and New Zealand have introduced significant reforms focusing on educational value and generalist experience (https://foundationprogramme.nhs.uk/programmes/2-year-foundation-programme/).⁴

The 2015 review of medical intern training commissioned by the Council of Australian Governments (COAG) found that internship had not adapted to changes in the health system, was not aligned with societal health care needs and played a limited role in supporting generalism.³ The reviewers noted variable learning experiences and supervision, and recommended expansion of training beyond public hospitals. They suggested a 2-year capability and performance framework with robust workplace-based assessment but recommended that completion of PGY1 should remain the point of general registration. They also suggested an AMC-auspiced certificate of satisfactory completion for PGY2 and investigation of options for an e-portfolio.

In 2018, COAG accepted most of the review's 20 recommendations.⁵ As the AMC had already established a working party for a scheduled 5-year review of the 2014 framework, COAG requested that the AMC working party address the relevant recommendations. The working party included expertise in medical education and medical administration, prevocational doctors, supervisors and PMC representatives.

Four subgroups were established to oversee the key framework components: training and assessment, training environment, quality assurance and e-portfolio. There was also a reference group with representation from all key stakeholders. The working party reported to AMC's Board of Directors through the Prevocational Standards Accreditation Committee. There was a second reporting channel to the Health Chief Executives Forum (HCEF, previously the Australian Health Ministers Advisory Committee).

The new framework was developed through four rounds of public consultations: an initial consultation on scope in 2019 and three consultations on draft framework components in 2020 and 2021. There were more than 150 meetings, presentations and workshops with stakeholders (including prevocational doctors, medical students, consumers, postgraduate medical councils, medical educators, specialty colleges, health services, and state and Commonwealth health departments). The final framework documents, including high level specifications for a national e-portfolio, were published in August 2022. Implementation commenced in January 2024.⁶

All states and territories introduced the new framework for PGY1 doctors in January 2024. New South Wales and the ACT also introduced the framework for PGY2 doctors. Other states and territories implemented PGY2 in January 2025. As EPA assessments have been designed for the e-portfolio, they will not be mandatory until the e-portfolio is delivered. However, many health services have commenced EPA assessments using paper-based forms or existing electronic learning management systems.

A suite of resources has been developed to support the new framework, including guides for prevocational doctors and their supervisors, FAQs (frequently asked questions), and slide packs, online modules and videos addressing specific components of the framework (assessment, EPAs, supervision, feedback, and Aboriginal and Torres Strait Islander components).⁶ Additional resources will be produced to support the e-portfolio.

In addition to delays in development of the e-portfolio and implementation of EPAs, there are two significant gaps.

The workforce crisis in Australian general practice is well documented⁹ and seems unlikely to be resolved without including community terms during the prevocational years, when most make their career choices.¹⁰ In the United Kingdom and New Zealand, prevocational training includes mandatory community terms.⁴ There was strong support for community terms during AMC consultations but agreement on requirements and funding for community terms is particularly challenging in Australia's federated health system. The AMC will consult again on including mandatory community terms in the first revision of the framework.

Improving supervision is constrained by relative under-resourcing of prevocational training. Mandatory training for term supervisors will have some impact but the goal should be appropriate recognition of the time and educational requirements of prevocational supervision.

Minor revisions of the framework may be introduced after the targeted review. A more detailed revision will take place after the 5-year review.

The new national prevocational medical education framework has been designed to improve the quality of prevocational training, make it more relevant to modern health practice and improve patient care. It is the result of extensive consultation with doctors, health services, jurisdictions and PMCs, and is the most significant reform to Australian prevocational training in the last 50 years.

No relevant disclosures.

Not commissioned; externally peer reviewed.