Changes to the format and delivery of the AMC Clinical Examination for IMGs


In September 2020, the AMC advised international medical graduates of an AMC project to recommence the clinical examinations in February 2021, The communication was also provided to other important stakeholders, such as MBA/Ahpra, and advised an update would be made available to in November 2020.

The AMC is now pleased to advise international medical graduates and stakeholders the project is progressing very well toward the initially communicated commencement date of February 2021.

Using an alternative online delivery method for the clinical examination the project is being developed beyond an initial response to COVID-19 and delivering the examination in a COVID-19 safe manner. The project and developments also present long-term opportunities to protect the AMC clinical examination from similar future disruptions, improve quality and accessibility of the examination for international medical graduates and examiners, and align the examination content with the AMC Assessment Strategy that is currently being developed following the AMC Assessment Summit held in October 2019.

A two phased approach is being undertaken:

  1. An initial objective to recommence the clinical examinations in February 2021, while ensuring examination validity and reliability remain consistent with the current clinical examination delivery. This requires a minimal change approach to content, blueprinting, operations, and technology to deliver the examination digitally.
  2. A second objective to implement broader principles of assessment, and different modalities, for the long term development and improvement of the clinical examination during 2021. This will require further technology development and retirement of legacy AMC technology.

This project is an important development for the AMC to enable international medical graduates to continue their progress towards registration for practice in Australia, and to continue the AMC’s leadership role in promoting and protecting the health of Australian communities through assessment.
 

Objective 1 – February 2021 & a description of the online delivery format

With the initial objective in February 2021, the online clinical examination delivery will retain the current structure of 16 stations with two unscored stations. The pass mark will remain at 10 stations. There will be no change to existing blueprinting, standard setting and monitoring processes. The Clinical Examination Results Panel will continue to analyse candidate and examination performance as it formally approves candidate results.

The backbone of the clinical examination delivery will be a triad between a candidate, a simulated patient and an invigilator. The invigilator will act as a case manager who will stay with the candidate throughout the examination, provide candidate tasks, introduce patients, and provide operational and technical support. The invigilator will also perform important security functions such as verification of the candidate identity.

All contacts will be conducted initially via the Zoom platform with added functionality enabling the recording of video and audio. The recordings will be made available to examiners for remote marking. This approach builds upon pilots conducted by the AMC in 2019 where examiners remotely marked video recordings of four examinations held at the AMC National Test Centre. Analysis confirmed improvements in marking ability with examiners being able to rewind and replay videos. This was supported by published trials of international affiliates. Feedback from international medical graduates participating in the pilot remote marking examinations also supported the development stating that patient encounters were more realistic without an examiner present.

The video and audio recordings will continue to be used by candidates in the AMCs established Appeals process. It is planned that the accessibility of Appeals video will be improved for candidates by eliminating time and costs associated with travel.

It is important to note that while the examination will be delivered online, it is not an assessment of telehealth skills. The examination, using an alternate delivery method, will continue to assess the application of clinical skills and knowledge in the domains of history taking, diagnostic formulation, management and counselling, and physical examination. To achieve this, the AMC is building upon its current use of multi-media at the AMC National Test Centre examinations, such as mental health videos and images, and extending these to the physical examination assessment domain.

The proposal paper for the online clinical examination delivery can be found here on the AMC website.
 

Pilot and mock examinations to help ensure successful project delivery

Pilot examinations with international medical graduates are intended to be held in the last week of February with mock examinations being conducted from the end of January. The mock examinations will involve Australian medical students from the AMC’s existing NTC Marshal Program. Helping to ensure quality delivery of the examination for international medical graduates, this approach of mock examinations with students and staff is designed to assist with testing technology and operations, calibrating the examination material, sourcing feedback from participants, and providing training to simulated patients and invigilators. A representative group of international medical graduates will also be engaged for feedback and input throughout this stage of the project.
 

Online examination scheduling and broader examination opportunities

When clinical examinations were originally cancelled in response to COVID-19, many candidates elected to retain their payment with the AMC to receive priority scheduling with the recommencement of the examinations from February 2021. These candidates will be provided with priority scheduling which will be communicated in early December 2020.

The examination will be made available initially to Australian based candidates with the early examinations. In anticipation of a successful launch, the examination is intended to be made available to overseas candidates with priority also provided to the overseas candidates who retained their payment with the AMC for priority scheduling.

In December 2020, an in-situ clinical examination is being conducted for candidates residing in Canberra. This approach may be possible at other sites. However, it is planned that after the initial launch of the online clinical examination delivery, the approach to content development and remote marking may enable the re-opening of the AMC National Test Centre with allowances for social distancing. This will be dependent upon COVID-19 conditions at the time. If successful, this will provide further options for international medical graduates to undertake the examination.
 

Sharing knowledge and experiences with other institutions

Since COVID-19 required the cancellation of examinations for Australian medical schools, colleges, and international affiliates, the AMC has maintained regular contact with several institutions regarding response plans and alternative examination approaches using online assessments. The objectives of conducting meetings and correspondence with other institutions is to share experiences and knowledge. Each institution is then able to consider shared information and then apply learnings in the context of their own assessment projects and developments.

These meetings were recently complemented by a successfully delivered forum of medical colleges organised by the AMC. Outcomes of the forum and working with AMC affiliates has further confirmed the AMC project approach is consistent with others institutions. The AMC approach also includes further developments that will benefit international medical graduates as improvements are undertaken in 2021 and beyond.

This overall approach to working with other institutions in Australia and overseas is helping to ensure the AMC continues demonstrating leadership through being an early adopter and disseminator of innovative clinical assessment in COVID-19 safe environments and into the post-pandemic period.

The health and safety of all examination participants, the interests of international medical graduates who are important to our health services, and the health of Australian communities, all remain an important priority for the AMC with this project and future strategic developments.

Due to the AMC office closure, the Clinical team is unable to attend to any phone contact. Please contact the Clinical team by using this link: https://www.amc.org.au/about/contact-the-amc/. Further communication to candidates and stakeholders will be distributed early December 2020.