Prevocational training - PGY1/PGY2 & NZREX requirements
Prevocational medical training applies to graduates of New Zealand and Australian accredited medical schools and doctors who have sat and passed NZREX (interns). Interns must work at a Council accredited training provider (DHB) in accredited clinical attachments under the supervision of a prevocational educational supervisor. Prevocational medical training requires each training provider to deliver a 2-year intern training programme with specific requirements for postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2).
- Intern training programme
- Requirements for PGY1 and gaining a general scope
- Clinical attachments
- Professional development plan (PDP)
- Advisory panel to recommend registration in a general scope of practice
- Requirements for PGY2
- Community based experience
Council accredits training providers (DHBs) that have demonstrated they meet Council’s Standards for accreditation of training providers to deliver a 2 year intern training programme. For further details please go to the accreditation page.
The aim of the intern training programme is to ensure that interns further develop their clinical and professional skills gained at medical school. This is achieved through completing 13 week attachments that provide a range of clinical experience, under the close supervision of senior doctors and more senior trainees. This will allow interns to substantively attain the learning outcomes in the New Zealand Curriculum Framework for Prevocational Medical Training (NZCF). The intern training programme is based on adult learning principles and has at its core a personally developed professional development plan (PDP).
During PGY1 interns will record their learning in their ePort. This includes maintaining a PDP and recording the learning outcomes attained from the NZCF (including prior learning). Interns will meet with their prevocational educational supervisor at the beginning of the year and after each clinical attachment and will meet with their clinical supervisor on the clinical attachment at the beginning, mid-way through and at the end of each clinical attachment.
To apply for registration within a general scope of practice an intern must meet the following requirements:
- The (satisfactory) completion of four accredited clinical attachments.
- The substantive attainment of the learning outcomes outlined in the NZCF (prior learning will be taken into account).
- Completion of a minimum of 10 weeks full-time equivalent in each clinical attachment. Full time is equivalent to a minimum of 40 hours per week.
- Advanced cardiac life support (ACLS) certification at the standard of New Zealand Resuscitation Council CORE level 7 less than 12 months old.
- A recommendation for registration in a general scope of practice by a Council approved advisory panel.
In addition, interns are required to establish an acceptable PDP for PGY2, to be completed during PGY2.
Clinical attachments must meet Council’s standards for accreditation of a clinical attachments. The standards ensure every clinical attachment provides a quality educational experience with appropriate supervision. A clinical attachment will span 13 weeks (or 14 weeks maximum) and have at least one (and up to four) named clinical supervisors registered in the relevant vocational scope of practice who will be responsible for meeting with the intern (beginning, mid and end of the attachment) to provide formal feedback on the intern’s progress and performance.
New Zealand Curriculum Framework for Prevocational Medical Training (NZCF)
The NZCF outlines the learning outcomes to be substantively completed in PGY1 and by the end of PGY2. These learning outcomes are to be achieved through clinical attachments, educational programmes and individual learning, in order to promote safe quality healthcare.
The learning outcomes in the NZCF are underpinned by two central concepts:
1. Patient safety
Patient safety must be at the centre of healthcare and depends on both individual practice and also effective multidisciplinary team work.
2. Personal development
Throughout their careers, doctors must strive to improve their performance to ensure their progression from competent through proficient to expert practitioner, with the aspiration always to provide the highest possible quality of healthcare.
At the beginning of PGY1 interns will be able to identify and take into account learning from their prior years and record this as prior learning in ePort.
For further information about the NZCF and the learning outcomes click here.
A PDP is a short planning document compiled by the intern, with input from their prevocational educational supervisor and the clinical supervisor on each attachment. The PDP will assist the intern to reflect on achievements to date and identify what they need to learn and need to consolidate in order to substantively attain the learning outcomes in the NZCF. It will help to structure and focus learning, strengthen existing skills, and develop new skills. The PDP can also help the intern to focus on their vocational aspirations. The PDP is regularly reviewed and updated throughout PGY1 and PGY2.
Development and endorsement of the PDP for PGY2
Towards the end of PGY1 interns need to consider what they need to learn, need to consolidate and want to learn in PGY2 in order to develop their PDP for PGY2. The prevocational educational supervisor and intern should meet to discuss the PDP for PGY2. The DHB advisory panel is responsible for endorsing the PDP for PGY2 as acceptable when they consider the intern’s overall performance and progress for PGY1 and assess whether the intern has met the requirements for registration in a general scope of practice.
The goals in the PDP should be targeted around the following:
- Outstanding learning outcomes from the NZCF that have not been completed in PGY1.
- Learning outcomes from the NZCF that are stipulated for PGY2.
- Areas for improvement identified on previous clinical attachments.
- Multisource feedback results (if completed).
- Community based experience.
- Vocational aspirations.
ePort is the e-portfolio system used by interns to record learning and track progress. Every intern will have their own ePort account that allows them to record the learning outcomes from the NZCF that have been attained, create and update their PDP, record CPD activities and view their assessments. Prevocational educational supervisors can access the ePort of the interns they supervise to record feedback and provide educational support. Clinical supervisors can access the ePort of the interns they supervise, for the duration of supervision, to provide feedback on performance and progress and complete assessments.
Assessment will be on the job and multi-facetted and will be based on a high level of trust that assumes that nearly all interns will exceed the minimum levels of competence.
An overview of the assessment process can be found here.
Each intern is assigned to a prevocational educational supervisor at their training provider. A prevocational educational supervisor is a Council appointed vocationally registered doctor who has oversight of the overall educational experience of a group of PGY1 and/or PGY2 doctors as part of the intern training programme.
On each 13-week clinical attachment the intern will be under the supervision of one or more clinical supervisors named as part of the accreditation of that particular clinical attachment. Clinical supervisors must be vocationally registered senior medical officers in the vocational scope relevant to the clinical attachment and be in good standing with the Council.
The clinical supervisor is responsible for meeting with the intern at the beginning, mid-way and at the end of the clinical attachment to provide formal feedback on progress and performance and review the intern’s ePort, specifically the PDP. The clinical supervisor must also complete the End of clinical attachment assessment.
Download Guide for prevocational educational supervisors (June 2015, PDF, 812 KB)
Download Guide for clinical supervisors (June 2015, PDF, 562 KB)
For further information on supervision please go to the supervision section.
At the end of PGY1 when an intern has satisfactorily completed four clinical attachments, an approved advisory panel (within each training provider) will meet to discuss the overall performance of each PGY1, assessing whether they have met the required standard to be registered in a general scope of practise and proceed to the next stage of training. The advisory panel will hold the responsibility for endorsing the PDP as acceptable for PGY2.
The advisory panel will make a recommendation to Council, who as regulator is the decision maker.
Each training provider will establish an advisory panel comprising of the following four members:
- a CMO or delegate
- 2 x prevocational educational supervisor (one must be the intern’s own)
- a lay person.
The use of an advisory panel adds further robustness to the assessment of interns and will ensure that prevocational educational supervisors are better supported, and not placed in the role of advocate and judge.
- The advisory panel will review the information stored in the intern’s ePort to inform their recommendation.
The recommendation of the advisory panel will take account of the following factors:
- The intern is actively engaged in ongoing learning and is responding to feedback.
- The intern has addressed sufficiently all issues arising from the ‘requires development’ sections of the End of Clinical Attachment Assessment, particularly those that have any implications on safety to practice.
- The intern has met a substantive proportion of the learning outcomes in the NZCF.
- The intern is making progress to meet all the learning outcomes in the NZCF.
Download Guide For The Advisory Panel (July 2015, PDF, 479 KB)
Once an intern is approved registration in a general scope of practice they will begin working towards meeting the requirements for PGY2 which are as follows:
- Interns must complete four Council-accredited clinical attachments. All accredited clinical attachments are for 13-weeks.
- Interns need to continue to work towards achieving the goals in their professional development plan (PDP) for PGY2.
When an intern is approved registration in a general scope of practice an endorsement reflecting that they are required to work in Council accredited clinical attachments and continue to maintain a PDP will be included on their practising certificate for the PGY2 year, under the competence provision of the HPCAA.
At the end of PGY2, interns must demonstrate through the information in their ePort that they have met the prevocational training requirements and achieved their PDP goals. The prevocational educational supervisor will then recommend the intern’s endorsement be removed from their practising certificate as part of the practising certificate renewal process.
If the intern has not met the PGY2 requirements at that time, then the endorsement will remain.
On removal of the endorsement, the doctor will be required to enrol and participate in the Council approved recertification programme for doctors registered in a general scope of practice, administered by bpacnz, unless entering an accredited vocational training programme.
Interns will continue to be supervised by a prevocational educational supervisor and will be under the supervision of the named clinical supervisor on the particular clinical attachment, who will be responsible for providing formal feedback to the intern and meeting with the intern at the beginning, middle and end of the clinical attachment. It is recognised that the level of day to day supervision required for PGY2 will decrease, as the intern moves to more independent practice. Accredited clinical attachments will ensure an ongoing quality learning environment and an appropriate level of support.
Flexibility in meeting the PGY2 requirements
The intention is for PGY2 to provide a greater degree of flexibility in terms of an intern’s ability to take leave, have flexible working arrangements, enter vocational training or practise overseas. While the prevocational training framework outlines the competencies that need to be attained, also it is time-based with Council being clear that experience over time is necessary to further develop and consolidate the identified NZCF learning outcomes.
Download Prevocational Medical Training Requirements for PGY2 (11/2/2015, PDF, 1 KB) for further information about flexibility in PGY2.
Taking leave or having flexible working arrangements
When an intern takes time out during PGY2, this effectively pauses their training and on return to practice they will need to continue working towards the prevocational training requirements for PGY2. Therefore, if an intern takes leave for a full clinical attachment they will need to complete an additional clinical attachment in order for their prevocational educational supervisor to consider recommending the endorsement on their practising certificate be removed.
See Prevocational Medical Training Requirements for PGY2 for further information.
Working overseas in PGY2
There is flexibility for interns to practise overseas during PGY2 and the time practised overseas may be able to be counted towards the PGY2 requirements. Interns would need to provide the Advisory Panel at their DHB with information about their intentions and a proposed PDP at the time the Advisory Panel are reviewing the PGY1 progress.
The advisory panel may approve all or part of PGY2 requirements to be completed in Australia, UK or Ireland subject to one of the following:
- Within Australia – a prevocational training position under the supervision of a vocationally (specialist) registered doctor in a position approved for prevocational training.
- Within the UK – a position in an approved practice setting that has been recognised by the GMC for prevocational training in the UK.
- Within Ireland - a supervised position approved by IMC for prevocational training.
The Advisory Panel will need to consider whether the proposed PDP is appropriate for that intern and will allow for continued structured learning and assessment similar to New Zealand clinical attachments.
Interns will need to continue to maintain their record of learning in their ePort and work towards their goals in their PDP while practising overseas. This will include uploading completed supervision reports for time pactised overseas. This is similar to UK graduates completing Foundation Year 2 while practising in New Zealand.
On their return, a review of the completed supervision reports from the time spent overseas and the intern’s overall progress as demonstrated in their ePort is required, before a recommendation can be made to remove the endorsement on their practising certificate.
See Prevocational Medical Training Requirements for PGY2 for further information.
Vocational training in PGY2
There is flexibility for PGY2s to enter a formal vocational training early. Interns entering vocational training during PGY2 will have an endorsement on their practising certificate requiring them to satisfactorily participate in the vocational training programme as part of their PDP. They will need to enter a PDP goal that describes their intention to satisfactorily participate in the specific vocational training programme during PGY2. Once the intern has satisfactorily completed 12 months of requirements for their vocational training programme and, has provided verification from their vocational training programme supervisor, they may apply to have the endorsement on their practising certificate removed.
In this case the intern would not be working in Council accredited clinical attachments, but rather within the vocational college training framework.
See Prevocational Medical Training Requirements for PGY2 for further information.
Every intern is required to complete one clinical attachment in a community based setting over the course of the two intern years (PGY1 and PGY2). Completing a clinical attachment in a community setting will familiarise interns with the delivery of health care outside the hospital setting. This will assist interns to understand the interface between primary and secondary care.
Council approved a staged transition, with a goal of 10% of interns completing a community based clinical attachment in the year commencing November 2015 and working towards 100% compliance by November 2020. Training providers will need to demonstrate progress over this period.
The definition of a community based attachment can be found here