The Australian permanent resident international medical graduates (PRIMGs) study.

One of the long term solutions to recurring medical workforce shortages in Australia has been to recruit international medical graduates (IMGs). IMGs have been employed since 1788 but there have been few consistent and transparent guidelines and practices for their employment. IMGs are a key part of the Australian health workforce and therefore their selection, training, testing and support is important to safe and effective health care in Australia. However, to achieve the best health outcomes there needs to be a balance between the needs of the health care system and ensuring IMGs' wellbeing and career development. This thesis explores the IMG issue in regard to one particular category of IMGs - IMGs who are also permanent residents of Australia or Australian citizens. We more commonly hear about and research Temporary Resident IMGs (TRIMGs) but we know very little about Permanent Resident IMGs or PRIMGs and their experiences. Accurate data on the number and experiences of PRIMGs is difficult to find. However PRIMGs are important because they have made a commitment to Australia and are arguably entitled to receive support and encouragement to re-qualify and, if suitable, gain employment as high quality Australian doctors. PRIMGs offer a relatively untapped source of doctors to reduce workforce shortages. Yet many of them currently receive no funded training and receive little support to facilitate their re-qualification. One exception to this was the 2004 Commonwealth funded ‘RACGP-PROTD’ project. This project funded an assessment of the PRIMG’s current qualification status and training needs; the development of individual learning plans; the appointment of a supervisor and the provision of subsidies for books and other training requirements. This initiative was aimed at getting PRIMG’s registered and into the Australian medical workforce. The cohort of PRIMGs enrolled in this RACGP project was the most clearly identifiable group of PRIMGs we could locate. Therefore we decided to explore their experiences. This thesis will argue that it is important to understand and incorporate migrant and adult education theories when considering IMG re-qualification. The work of Knowles et al (2005), Bokken et al. (2009) and Kolb (1984) amongst others is important in helping us to understanding PRIMG experiences. The work of some very influential Australian researchers such as Michael Kidd, Bob Birrell and Lesleyanne Hawthorne was also informative. However hearing from the PRIMGs’ themselves adds important new knowledge to this field. A questionnaire was administered to the RACGP cohort. The questionnaire was approved by the RACGP, piloted with nine non-participant PRIMGs and was mailed out by RACGP staff to all PRIMGs on their project database. A modified Dillman’s method was used to maximize the response rate. Ethics Committee approval was received from Monash University and from the RACGP. The questionnaire had three sections, section one personal and demographic background, section two educational experiences and section three social experiences. Quantitative questions and sub-questions were followed by an open-ended qualitative free text section. The questionnaire ended with a qualitative ‘final comments’ section. The response rate to the questionnaire was 62% (198 of 321). Most of the PRIMGs in this study were older and they were more likely to be female. In the main they lived in metropolitan New South Wales and Victoria. Most came from China, Afghanistan, Philippines, Russia, Bangladesh and Myanmar. For most respondents, English was their second or third language. The cohort was appreciative of the support they received from the RACGP-PROTD project. The respondents reported that their clinical exam performance was weaker than their written exam results. Therefore they requested structured training and supported exposure to clinical settings and patients before sitting for clinical exams. Despite their difficulties in re-qualifying most of the respondents reported that they were healthy and happy. All groups in the cohort identified that needing to earn a living to support partners and families was a barrier to their re-qualification as was the high cost of accreditation related fees. In Australia we are not at present maximising gains for the health system or for individual medical migrants. On the basis of this research we have made fourteen recommendations to address the need for effective teaching and educational support and improved policy and financial support for PRIMGs. Finally in response to the cohort’s requests for a short, structured University course to aid their re-qualification a model course was developed. This course would cover cultural issues, language skills, behavioural skills, medical knowledge and practical skills and would also include supported clinical exposure via simulation and real patient contact in participating hospitals