WORLDWIDE, MEDICAL UNDERGRADUATE TRAINING is provided by universities where students graduate with a bachelor’s degree in medicine and surgery (MBBS mostly) which gives them the basic foundational knowledge on which they then continuously build on as they begin and progress through their medical careers.
After graduation, the new graduates spend the first one or two years doing rotations in the major medical fields gaining hands on experience and begin to work out for themselves what medical specialist career they’re interested in pursuing.
In Australia this is the Intern year, while in Papua New Guinea this is the pre-registration: Resident Medical Officers (RMO) program.
In PNG the satisfactory completion of the RMO program is a compulsory requirement for full registration with the PNG Medical Board as stipulated in the Medical Registration Act 1980.
During the two years the junior doctor, who is given a provisional registration status with the Medical Board rotates as follows through the seven major fields of medicine: internal medicine (adult medicine) 4 months; surgery 4 months; paediatrics 4 months; obstetrics and gynaecology 4 months; emergency medicine 3 months; anaesthesiology 2 months; rural attachments 3 months.
During their attachments the doctors work under supervision alongside senior colleagues and learn the ropes of working as a doctor in PNG.
They get as much hands on experience as possible with the various procedures and become competent in managing the many medical conditions to enable them to work as independent primary health doctors when they attain full registration.
After satisfactorily completing this rotation and meeting the requirement of the PNGMB as stipulated in the Medical Registration Act 1980 they attain full registered medical officer status.
Once fully registered, doctors are basically free to practice medicine and charge for their services with relatively little ongoing regulatory requirements.
The current Medical Registration Act 1980 only stipulates the requirements for a doctor (and dental officer and other allied health workers) to get registered for the different classes of registration, but does not have any specific requirements or limitations when it comes to how, what and where a practicing doctor in PNG with full registration (whatever the class of registration) can practice.
Essentially this means that any registered doctor can legally perform major surgery on a consenting patient. Most doctors know their individual professional limitation and perform within these limits.
The draft Medical Practice and Registration Bill provides some legal basis for the limitation and regulation of medical practices in PNG appropriate to the level of training and skills of the doctors.
Paragraph 21 of this Bill stipulates conditions applying to a registered person – which includes, level of required supervision, what tasks/procedures an applicant can or cannot perform, capacity at which an applicant can practice, period of time within which the applicant can practice.
The Bill also outlines certain specific conditions applying to overseas trained doctors or non-citizens
In the current laws there are also no requirements for continuing professional development (CPD) and the onus to keep updated with current medical knowledge rests solely on each individual doctor.
This can be difficult with limited resource and not being a part of an institution with in an inbuilt culture of and set program for CPD.
In PNG, the current benchmark for a structured post-graduate curriculum is the Master in Medicine program offered by the much under-resourced University of Papua New Guinea which, as well as offering the only undergraduate medical course in PNG also offers a number of specialist programs for specialist candidates, who upon successful completion are then recognised as specialist consultants by the PNGMB.
While UPNG endeavours to provide the highest quality of training within its resource constraints, the quality of training in the MMed program varies between cohorts of candidates and within a cohort depending on the level of supervision (internal and external), extent of overseas (to a country with high modern standards of healthcare like Australia) exposure and other factors.
On the whole the number of MMed candidates given an opportunity to gain experience in Australia and other developed countries has declined dramatically since the MMed was introduced at UPNG.
Part of the reason is because of tighter regulatory requirement for overseas doctors to gain even limited registration in Australia and also quite possibly due to the lack of established professional bodies in PNG for the major fields of medicine that can engage in dialogue with their overseas counterparts and advocate trainees to have attachments in Australia.
The draft Medical Practice and Registration Bill, if passed into law, can provide some ways forward in terms of post-graduate training and CPD which will no doubt improve the quality of medical practice in PNG.
In particular, there will be opportunities for the various professional bodies to organised programs for postgraduate training/qualifications and CPD program for their respective fields.
For example the physicians can set up a PNG College of Physicians which can set the benchmark for physician training and CPD programs.
As a professional body the PNG College of Physicians can be both the regulator and the advocate for PNG physicians. They could re-establish links with their Australian (or other country) counterparts to ensure their programs continually improve and are of world standards.
The Draft Medical Practice and Registration Bill will be an important ingredient for the evolution of medical training and practice in PNG, but the question remains: Are the individual professional bodies mature enough now to take the reins off UPNG?
I believe this Bill will get passed soon and once it becomes law it will be a legal requirement for doctors to take part in CPD programs.
It is inevitable that the future of post-graduate medical training in PNG will shift away from UPNG to individual professional bodies.
It will interesting to see which professional body will be the first to get organised and set up credible post-graduate and continuing professional development programs worthy of recognition by the Papua New Guinea Medical Board.