Policy Statement

Runs are assessed as A, B, C or D (see Appendix 1).  Interns are required to complete minimum run requirements to ensure they have the opportunities for wide experience and development of skills.

Rationale

Council believes that the safest and most valuable learning experience will take place where interns are directly supervised by more senior staff and are comfortable with the responsibilities placed upon them.

Council approves runs to ensure interns have a good educational experience and development of objectives, adequacy of supervision, assessment and feedback.

There are more run requirements for interns who have passed NZREX than those interns who are New Zealand or Australian graduates.  This is because NZREX graduates are more likely to take more than 12 months to complete their provisional period and are more likely to have gaps between the runs.  Often they are only offered a three month contract, necessitating Council’s additional requirements.

Run requirements for New Zealand and Australian graduates

1.            To move from a provisional general scope of practice to a general scope of practice interns who are New Zealand or Australian graduates must satisfactorily complete:

·                at least four runs, including:

–              one category A medical run

–              one category A surgical run

–              two other runs which may be category A or B runs

·                three consecutive runs immediately prior to applying for registration in a general scope of practice

–              at least two of these three consecutive runs must be in different disciplines.

2.            The intern must also:

·                be recommended for registration in a general scope of practice by the intern supervisor

·                work for no less than 10 weeks per run (any intern completing less than 10 weeks per run need to be assessed as satisfactory by the intern supervisor and will be considered on a case by case basis by Council as to whether they have satisfactorily completed that run).

·                be certified in ACLS within 12 months or resit the full or a refresher course when seeking to move to a general scope of practice (see policy on interns certifying in basic and advanced ACLS).

3.            The intern may work:

·                in rotation or relieving A or B runs

·                in Council accredited general practice runs.

Run requirements for NZREX graduates

4.            To move from a provisional general scope of practice to a general scope of practice interns who are NZREX graduates must satisfactorily complete:

·                at least four runs, including:

–              one category A medical run

–              one category A surgical run

–              two other runs which may be category A, B or C runs (NZREX graduates must not work in category D runs)

·                three consecutive runs where overall performance is of the standard expected immediately prior to applying for registration in a general scope of practice

–              at least two of these three consecutive runs must be in different disciplines

5.            The intern must also:

·                be recommended for registration in a general scope of practice by the intern supervisor

·                work for no less than 10 weeks per run (any intern completing less than 10 weeks per run need to be assessed as satisfactory by the intern supervisor and will be considered on a case by case basis by Council as to whether they have satisfactorily completed that run).

·                be certified in ACLS within 12 months or resit the full or a refresher course when seeking to move to a general scope of practice (see policy on interns certifying in basic or advanced ACLS).

6.            The intern may work:

·                in rotation or relieving A or B runs (after six months may do category C rotating or relieving runs)

·                in Council accredited general practice runs if they have previously worked in general practice or family medicine.

Definitions

Satisfactory completion of a run

A run is satisfactorily completed if:

7.            the intern obtains a rating of “overall performance is of a standard expected of a registered practitioner” on their RP2 end of run report form, or

8.            the intern supervisor has made a case to Council for the inclusion of one run where “overall performance is marginal” in their recommendation for registration in a general scope of practice.

A marginal run

Overall performance on a run is marginal if:

9.            the intern obtains a rating of “overall performance on this run is marginal” on their RP2 end of run report form, or

10.        the intern scores a 2 in only one of the 19 assessed competencies.

A failed run

Overall performance does not meet expectations if:

11.        the intern obtains a rating of “overall performance on this run does not meet standards required of a registered practitioner” on their RP2 end of run report form, or

12.        the intern scores a 1, or more than one 2, in the 19 assessed competencies.

Note

13.        If a doctor fails to satisfy the conditions on his or her practice as required by Council to ensure competent practice within a general scope of practice within two years, the Registrar will refer the doctor’s application for an APC to the Council under section 27(1)(b) of the Health Practitioner’s Competence Assurance Act 2003.  The Council may:

·                extend registration within a provisional general scope for a further period, or

·                propose to either place restrictions on, or decline to issue the doctor’s ACP under section 28 of the Act, and give the doctor an opportunity to make written submissions and be heard by Council, and

·                then make a decision whether to issue the APC.

14.        NZREX graduates must work under the supervision of a Council appointed intern supervisor.

15.        Council requires employers of NZREX graduates to ensure the following:

·                induction (not less than one month) to NZ culture and clinical practice

·                support and close supervision by the clinical team

·                assessment and feedback by the consultant supervisor or general practice supervisor, based on team consensus; and

·                overall monitoring by the intern supervisor.

16.        Employers and supervisors have reported that NZREX graduate interns have difficulties in two distinct areas and Council would expect any induction/orientation to cover the following:

·                New Zealand Culture

eg, communication in the broadest sense, understanding of cultural issues, patient expectations and rights, informed consent, ethical principles, medico-legal framework, working in a multidisciplinary team, especially with female team members.

·                Clinical and practical skills

eg, clinical judgement, application of medical knowledge, management and assessment of common problems, problem solving and decision making skills, dealing with emergencies and acute work, clinical record keeping, documentation, prescription writing, completion of certificates, insertion and removal of intravenous lines.