In the internet age, medical networking is now international. However, occupational nomenclature is dragging behind. So I am going to briefly clarify the Aussie training system.
When I went through medical school (in the nineties), it was a 6 year undergraduate course. After a review, they cut out a lot of “unnecessary” bits of med school (like anatomy). Now there is a choice between 5 years undergrad, or 4 years postgrad.
Basically, a resident or hospital medical officer (HMO) is a medical graduate with no further training. All HMO’s have a supervising senior doctor, usually a registrar. Residents are not usually officially committed to any specialty training program, at least initially.
Interns are first year residents (or HMO1’s). All interns must work general medical, general surgical and ED rotations. Interns (and most residents) don’t work classical medical hours. Usually no on call, and around 40-60 hours per week, depending on the rotation. Night work is customary, but it is followed by an 8am handover and a trip home to sleep.
Becoming a registrar
After 2-4 years of residency, doctors jump a hurdle into training. Some programs require an entrance interview, or first part exam, or both. A training doctor is a registrar and works as an apprentice to their supervising consultants within the hospital.
For example, a medical registrar (internal medicine) might admit and manage patients without much consultation, but have the ability to call for advice if required. The other responsibility of registrars is to study for fellowship exams.
General Surgical training
Sometime after about HMO2, doctors can apply to the surgical training program. There is a basic science exam and OSCE, which they have to successfully complete prior to acceptance.
As a general surgical registrar, I work as an apprentice to my consultants on 6 month rotations in different geographic or subspecialty areas. Over that six months, I need to impress them with my skills so they let me do more cases as primary operator, and make more decisions about patients who are inpatients. My share of supervised responsibility and operating will increase slowly over 4 years.
At the end of training, I sit an exit exam (short cases and MCQ) and then have the options of working more years as a fellow, to get further training in any particular area.
The length of training and age of fellows
Of course, I have complicated this cascade by choosing to do a PhD. This credits me one year of training (i.e. I will only have to complete 3 years), so extends my total training time by 2 years. I am likely to sit my fellowship exam in 2011, when I am 36. At that stage, I will be able to choose to work in private and without supervision.
This seems excessively old, and it is. I have extended my training by having two kids along the way, but even if I went through without pause and without research, I would have had 7 years from the end of medical school until fellowship. I would have been 31.
So here it is in point form:
- Medical school (5 years undergrad, 4 years postgrad)
HMO2, 3 and even 4
- Specialty training
Up to five years as a Registrar
+/- Entry exam
+/- Exit exam
- Subspecialty training
Variably optional years as a fellow getting further experience in specific areas with consultant back up
Finally, the ability to work in private and unsupervised.
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