Working under supervision

All international medical graduates (IMGs) registered in a provisional general, provisional vocational and special purpose scope of practice must be supervised. This is to support their practice while they become familiar with the New Zealand health system and the expected standard of medical practice.

The purpose of supervision

Supervision supports a doctor's practice and enables a doctor’s performance to be assessed, over time, while they become familiar with:

  • the New Zealand health system
  • the required standard of medical practice.

It assures Council that a doctor is able to practise safely, with support and oversight, until the doctor is able to demonstrate that they are able to practise competently and safely, independently.

Good supervision

Supervision provides guidance and feedback on personal, professional and educational development of doctors within the context of providing safe and appropriate patient care.

Good supervision should enable the doctor to review and develop their practice in a supportive environment, and enhance their knowledge, skills and professionalism. In addition, supervision encourages a culture of continuous learning and development. We support both formal (scheduled and planned) and informal supervision.

Vocationally-registered doctors supervise IMGs

An IMG is supervised by a doctor who is registered in the relevant vocational scope for the area of medicine in which the IMG is practising. Council approves supervisors, who are typically nominated by the IMG’s employer.

Responsibilities of supervisors, IMGs and employers

We have a handbook Orientation, induction and supervision for international medical graduates, which provides detailed guidance on supervision requirements and the responsibilities of supervisors, IMGs and employers.

We must approve proposed supervision plans before a doctor starts practising, as well as approving any proposed alteration to the plan.

Responsibilities of supervisors

The general responsibilities of a supervisor include:

  • Ensuring that the IMG is participating in their orientation and induction programme.
  • Providing clarity about how both parties will communicate during normal working hours and after hours (where applicable). This includes setting ground rules for communicating with other team members.
  • Making sure that protected supervision time is scheduled regularly and kept free of interruptions.
  • Being readily available and approachable.
  • Where applicable, providing clear clinical notes and comprehensive management plans, which include parameters clarifying when specialist care is required for a particular patient.
  • Monitoring and verifying both what the IMG is doing and that they are capable of carrying out their duties competently.
  • Raising performance issues early. The sooner these are raised, the more opportunity there is for the IMG and their supervisor to work together to address them.
  • Identifying whether poor performance is caused by poor communication skills and making arrangements for communication skills tuition, when necessary.
  • Arranging to regularly review the IMG’s understanding and knowledge of key clinical areas.
  • Understanding the requirements that the IMG must complete in order to gain full registration (for those on provisional scopes), and providing support, where appropriate, to help the IMG meet these requirements.
  • Ensure the IMG is working within their approved scope of practice.

Responsibilities of the IMG

The general responsibilities of the supervisee (the IMG under supervision) include:

  • Engaging fully in the supervision process.
  • Ensuring an appropriate supervision schedule (for example, the formal meetings with the supervisor) is in place, diarising these appointments and giving it priority.
  • Working with the supervisor to set supervision and educational objectives.
  • Keeping a supervision logbook, including participation in continuing medical education activities.     
  • Communicating clearly and responsibly with the supervisor.
  • Being ready to accept constructive feedback, and being receptive to changing behaviour where necessary.
  • Taking part in audit and peer review or group activities.
  • Asking for advice appropriately.
  • Asking for more support or mentoring, should this be necessary.
  • Contacting the supervisor early on when concerns or issues arise, or when they feel out of their depth in any way.
  • Recognising limits of professional competence.
  • Obtaining approval from Council for any changes to supervision arrangements before they are implemented.
  • Obtaining approval from Council for any changes to conditions before they are implemented.

Informing Council if the conditions or requirements of supervision are not being met.

Responsibilities of employers

The general responsibilities of the employer include:

  • Ensuring supervision is provided according to Council’s policies.
  • Providing adequate 'protected time' for the IMG and supervisor.
  • Ensuring the IMG is familiar with organisational policies and procedures.
  • Advising Council of any concerns about the IMG if they form the opinion that there is a risk to the public that cannot adequately be addressed by implementing local measures.
  • Understanding the requirements that the IMG must complete in order to gain full registration (for those on provisional scopes), and providing support, where appropriate, to help the IMG meet these requirements.

When the IMG is practising below the expected standard

Supervisors should address any problems, including performance issues, at the earliest opportunity. Do not leave them to the end of the run, or the end of the doctor’s employment.

Many of these types of issues are best managed through remediation and robust supervision, and do not require more significant regulatory action.

Supervisors should report significant concerns to their employer and to Council. Supervisors shouldn’t wait until a supervision report is due.

Supervision reports

Supervisors of IMGs must provide a supervision report to Council every three months. On the report, supervisors are asked to assess the standard of practice of the IMG in relation to:

  • Knowledge and skills
  • Clinical judgement
  • Communicating with patients
  • Communicating with the team and teamwork
  • Professional attitudes and behaviour.

Before submitting the report to Council, a supervisor should discuss the report with the IMG they are supervising. This gives the IMG an opportunity to provide feedback and for the report to be checked for accuracy and fairness. It also allows supervisors to reflect on areas where they could provide additional support and guidance.

Discussing the report first with the IMG is particularly important if there are any concerns about their practice identified in the report.

After a supervisor has submitted the report to Council, the IMG is invited to review and acknowledge the report.

The supervisor and the IMG are jointly responsible for ensuring that reports are promptly provided to Council.

Access to supervision reports

Supervision reports help Council ensure doctors are practising competently and safely in New Zealand. They inform decisions about registration and the issuing of practising certificates. Supervisors will have access to previous reports provided through the online supervision report portal about an IMG they are supervising.

We may also share supervision reports with new supervisors or the employer’s chief medical officer (or equivalent in a non-DHB environment), particularly if concerns about the IMG’s practice are identified.

Information on providing supervision reports

Supervisors provide the report through an online portal, and IMGs review and acknowledge the report through the portal. This was launched in April 2021.

The portal is accessed via doctors’ MyMCNZ accounts . There is also a direct link in the emails sent to the supervisor or the IMG about supervision reports.

For supervisors, there is a step-by-step written guide for supervisors [PDF, 1.1 MB] on how to complete the report online.

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