Key recommendations

Abbreviations

1. Key principles to be adopted

• Transparently Fair
• Responsive
• Accountable
• People-focused

This follows the recent findings of the National Health Practitioner Ombudsman Report dated October 2023, Processes for progress, Part one: A roadmap for greater transparency and accountability in specialist medical site accreditation.

2. Publication of this Report

We recommend that the College publish this report to all interested parties, including the Resident Doctors Associations.

The College should commit to publishing an update in 12 months’ time detailing the recommendations that have been accepted and implemented.

3. Candidate Information and Q&A Sessions

The College should provide regular and comprehensive in-person or live online presentation of information for examination candidates.

4. Training for Examiners

All Aotearoa New Zealand clinical examiners should be offered, and if possible, attend the pre-examination training and calibration days in Australia or have them delivered in person in Aotearoa New Zealand. This training should include expert providers delivery of unconscious bias and cultural training annually.

5. Unconscious Bias Training and Cultural Awareness Training

This training should be commissioned and developed for the College by external consultants who are expert in the field of this training, considering the differing indigenous contexts for Australia and Aotearoa New Zealand. This training should be compulsory for all examiners and delivered consistently and annually across all Examiner Calibration Training Days.

6. Manuals for Examiners

The College should prepare and distribute an up-to-date Clinical Examination Manual for Examiners as part of the training to confirm best practice standards, procedures, and conflict and conduct requirements for examiners.

7. Training for College Chairs

It's recommended that mandatory training is introduced for all College Chairs with reference to the JAMA Network Investigation, Māori Medical Student and Physician Exposure to racism, discrimination, harassment and bullying, July 2024.

8. College Quality Assurance Leads^ to attend

In each examination centre in both Australia and Aotearoa New Zealand, there should be a Quality Assurance Lead^ from the College present. It's recommended that a minimum of 10 examiners from Australia should assist in clinical examinations in Aotearoa New Zealand…and that New Zealand examiners attend examinations in Australia.

The College should also advocate with Health New Zealand, to achieve a more flexible assessment period similar to Australia, which will support improved examiner diversity. 

9. Examiners Conflicts of Interest Policy and Register

This conflicts policy should be documented and approved as a written College policy to ensure that all examiners declare if they have an existing working or personal relationship with an examination candidate. A conflict-of-interest form is required from all examiners.

The examiners should not be part of the examination panel for that candidate. A written Register of Interests should be prepared ahead of the examination.

10. Case complexity

It's recommended that the Clinical Examination marking sheet include a recording of the complexity of each case so that it can be considered in discussing failing candidates in the Examination Committee. This record will then be available in the case of any reviews or appeals.

11. Clinical examination changes to be considered

The Cross College Review of Examinations should consider video or audio recording of the clinical examinations in each centre, so that if there's a challenge to a clinical examination, it can be dealt with based on the recorded examination. The College could consider a trial of this technique.

It's also recommended that the College Review consider a change to the short case format.

It's recommended that the College allocate additional budgetary resources for sending candidates who have previously failed and/or a random selection of candidates to Australia for their examination.

Practice and Work Based Assessments should be considered in special considerations, if candidate health or other circumstances justify this approach.

12. Improved feedback to candidates

The College should improve the quantity and quality of feedback to candidates, from both the long and short case components of the Clinical Examination. Part of the calibration and training of examiners should include the provision of constructive feedback.

13. Ethnicity, gender and medical qualification data

The College should establish a system to gather the ethnic, gender and country of origin of medical qualification data of both examiners and candidates, so that the College is able to track and report on the diversity of candidates as compared with only aggregate pass and failure rate.

For quality assurance purposes, this data should be publicly reported including to College Trainees and relevant Resident Doctors Associations.

14. College Committee structure to be simplified

The number of Committees should be reduced to avoid overlap and role confusion. The Committees should ensure they each have clear written Terms of Reference and that these are made available on the College website. The names of the Committees should be sufficiently distinctive to allow easy demarcation for all College members.

15. Complaints process to include ability to seek review of examination outcome

The College should amend its complaints policy to include the ability to challenge the examination outcome, where there is an allegation of bias, discrimination or a decision that is otherwise outside the reasonable range of findings available to an examiner panel.

These are natural justice grounds of challenge that should be available to a candidate, beyond the current grounds for complaint which relate to special or extenuating circumstances that relate to the candidate. It's recommended that members of the College Trainee Committees are involved in the redesign of the complaints process.

16. Complaints process to be simplified

The pathway for complaint should be simplified with one senior College manager and office, responsible for receiving and administering the progress of all complaints. The determination of the complaint will still be delegated for determination by an appropriate Committee, but this should be one Complaints Committee with members trained to receive and deal with complaints, support by the College administration to ensure they are progressed promptly.

17. Clinical Examination Fee

The College should annually provide all candidates, the National Resident Doctors Associations and Trainee Committees, with a detailed explanation of the way in which their fee is used to meet the costs of the examination and administration within the College. Consideration may be given to reduced fee for second and subsequent examinations, where candidates are required to take the examination again in subsequent years and have financial circumstances that warrant consideration.

18. Apology by College to 2021 complainants for failure to deal with complainants in a timely manner

It's recommended that the College offer an apology to the anonymous complainants, via the New Zealand Resident Doctors Association and the College Trainee Committees, acknowledging the unacceptable delay in response to the complainants raised.