Accreditation, specialist training and recognition in Australia

Provisional training

This usually occurs in the third postgraduate year or beyond. There are three requirements of provisional training:

• Completion of 12 months of training in approved rotations. At least 6 months of this must be in an accredited ED. Each term, which must be of at least 2 months’ duration, is assessed via a structured in-training assessment (ITA) by the DEMT and or local supervisor for non-ED rotations.

• Successful completion of the ACEM primary examination. This is an integrated basic science examination with written and oral components covering four subjects: anatomy, pathology, physiology and pharmacology. The written component must be passed before the oral component can be attempted. The written exam involves two 180-minute papers consisting of select choice questions, multiple choice questions and extended matching questions. Candidates must achieve a global pass score across the two papers combined. The integrated oral examination comprises four 10-minute sections each assessing across the four science subjects as well as a clinical building block. The latter is an abnormal pathology result, radiological image or ECG that candidates are expected to describe and interpret. The standard of the clinical building blocks is at the level expected for a provisional trainee. Many of the questions in the written and oral examinations are linked by a clinical scenario to demonstrate the clinical relevance of the topic.

• Provision of three structured references. Each trainee must obtain three structured references as supplied by the ACEM from their DEMT and two other fellows who have supervised 6 months of their ED provisional training time. These seek to identify strengths and weaknesses in a number of areas of practice and serve as indicators of the trainee’s suitability to progress into advanced training.

Advanced training

Advanced training consists of three stages across 48 months. The main elements are core EM training, non-ED training, critical care training, discretionary training, the paediatric requirement, the research requirement and completion of the fellowship examination.

Core emergency medicine training

Trainees must complete 30 months of training in accredited EDs. Each 3-month term is assessed via a structured ITA by the DEMT.

Trainees must complete at least 6 months in a major referral hospital and 6 months in either an urban district or rural/regional hospital.

During core EM training, trainees are required to complete a suite of Emergency Medicine Workplace-Based Assessments (EM-WBAs). These involve a FACEM undertaking short periods of observation and/or discussion with a trainee in clinical practice, followed by structured feedback and a rating of the trainee’s performance. Types of EM-WBAs include mini-clinical evaluation exercises, direct observation of procedural skills, case-based discussions and shift reports.

Non-emergency department training

Trainees must complete a minimum of 6 months of training in approved non-ED rotations. These are usually in hospitals accredited for training by the respective college for that specialty. Experience can also be gained in the ACEM accredited special skills terms, such as pre-hospital and retrieval, trauma, toxicology, rural/remote health, ultrasound, research, medical education, simulation, safety and quality and medical administration.

Critical care training

Trainees are required to complete a minimum of 6 months in critical care medicine, either in an intensive care unit or an anaesthetics unit (or 3 months in each) approved for training by their respective colleges.