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Increasing the length of internship – what will we actually achieve?

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In 2015, a COAG review of Australian Medical Intern Training was completed. The intent of the review was to look at the internship model and assess if internship was producing “fit for purpose” clinicians. As part of the review, four models for change were proposed. Model A, the least revolutionary with no significant change to the structure but increased access to non-traditional settings including general practice, was the most preferred by doctors in training. Model B proposed shifting from a time-based internship to one focussed on specific mandatory skills and exposure to the “patient journey” and “different care contexts”. Models C and D were more revolutionary, with a proposed two year program either starting in the final university year or covering the first two postgraduate years.

As mentioned, the opinion of the AMA CDT and DiTs across the country at the time of the review was that, while there is always room for improvement, internship is not broken. Despite this, after the release of a COAG Health Council response to the review in July this year, we look to be pressing towards the two year model. 

In a postgraduate world, internship commencing during university would be unworkable for obvious reasons, so the current preferred model is an internship covering PGY1 and 2.

While on the surface this looks like significant change, what does the second year actually achieve?  There is agreement that general registration should be granted after successfully completing the first year, as it is now, so no change on the registration front. If it comes with increased opportunities for exposure to patients across the health spectrum and more structured learning, this will be to the advantage of doctors in training, the healthcare system and in the long run, our patients. It’s not clear though how this would be distinguishable from the current roles undertaken by PGY2 doctors.  Changing the role title to ‘intern’ does not automatically reduce the service requirements and increase the educational value of rotations – someone still has to write the discharge summaries.

One potential benefit would be an expectation that all rotations are accredited as suitable training environments by a Medical Board delegate (like the Post Graduate Medical Councils). Thankfully, this already happens in most jurisdictions, however, there is a danger that without additional resources, regions where it is not standard to accredit beyond PGY1 could see their accreditation processes watered down to meet demand.  Currently, the federal body responsible for the coordination of State/Territory-based accreditation bodies, the Confederation of Postgraduate Medical Education Councils, remains unfunded.  It seems absurd for the Government to push for change in the makeup of internship yet not fund the body responsible for enacting it.

Should we move to a two year model, we would also expect doctors in training be able to obtain job surety over the period of internship in the form of a minimum two year contract. This would be a sign of good faith from employing health services that they intend to train and support their doctors in training during this transition period.

AMA CDT’s position in 2015 was that internship is not broken and that position remains unchanged.  Without tackling the creep of increasing service need forcing education and training to become ancillary components of internship, it’s hard to see a second year bringing with it much improvement.