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An accreditation framework for prevocational education and training providers and training programs in NSW

DRAFT- VERSION 3g: 15 AUGUST 2014

Health Education and Training Institute

DOC 14/20217 2 (Draft) Accreditation framework for prevocational education and training programs and training providers in NSW

Table of Contents

INTRODUCTION ..................................................................................................................................... 3

The accreditation of training programs and providers ..................................................................... 3

The national case for change in accreditation processes ................................................................ 3

The NSW response to the national changes ...................................................................................... 4

PREVOCATIONAL EDUCATION AND TRAINING PROGRAM ........................................................... 5

LEGISLATIVE AND GOVERNANCE FRAMEWORK ........................................................................... 6

STAKEHOLDERS IN THE ACCREDITATION PROCESS .................................................................... 6

THE PREVOCATIONAL TRAINING ACCREDITATION FRAMEWORK .............................................. 7

Prevocational training accreditation ................................................................................................... 7

Scope of accreditation .......................................................................................................................... 8

Levels of accreditation ......................................................................................................................... 8

Accreditation process .......................................................................................................................... 9

Types of assessments .......................................................................................................................... 9

Prevocational training accreditation rating system ........................................................................ 12

Accreditation conditions .................................................................................................................... 13

Response options to the Assessment Report ................................................................................. 15

Assessment of departure from the standards ................................................................................. 15

Accreditation options for prevocational training programs ........................................................... 15

Monitoring accredited prevocational training programs ................................................................ 16

Methods for monitoring PTP compliance with accreditation standards ....................................... 16

Public Reporting ................................................................................................................................. 17

Review of standards and accreditation procedures ....................................................................... 17

REFERENCES ...................................................................................................................................... 19



INTRODUCTION The Health Education and Training Institute (HETI) accredits prevocational education and training programs and terms provided by Prevocational Training Providers (PTPs) in NSW against HETI’s Prevocational Education and Training Standards for Training Programs and Training Providers in NSW. HETI’s Accreditation Framework for Prevocational Education and Training Programs and Providers in NSW outlines the legislative and governance aspects underpinning accreditation; key stakeholders’ roles in accreditation and the NSW accreditation and re-accreditation processes applied to Prevocational Training Providers, and their programs and terms. Prevocational training providers (hospital, community health facility or a prevocational training network) are responsible for implementing the NSW Prevocational Education and Training Standards to support high quality patient care, meet service delivery needs and enhance the competency and skills of junior doctors.

The accreditation of training programs and training providers Accreditation based on a process of cyclic review by an independent authority is the preferred means of quality assurance for monitoring the phases of medical education in Australia.1 The accreditation of prevocational education and training, training programs and providers is advantageous for all key stakeholders, as it: • Provides a stimulus for medical education providers to review and assess their

prevocational medical education training program by conducting periodic review by peers; • Respects the autonomy of the medical education providers being accredited and

acknowledges their expertise and achievements; • Supports and fosters prevocational medical training initiatives and assists medical

education providers by drawing attention to their strengths and areas for improvement; • Benefits trainees, trainers, trainee employers and ultimately patient care and safety; • Provides external validation of standards of medical education and training programs.23

The national case for change in accreditation processes Several factors have recently impacted prevocational training program accreditation in Australia4. These include: 1. The establishment of a national registration authority and the Medical Board of Australia

(MBA) with a requirement for consistency of registration standards across the country.

2. The new guidelines produced by the Australian Medical Council (AMC) including: • National Standards for intern training programs;

1 Australian Medical Council. Procedures for Assessment and accreditation of Intern Training Accreditation Authorities by the Australian Medical Council. November 2013. 2 Ibid 3 Australian Medical Council. Procedures for Assessment and accreditation of Specialist Medical Education Programs and Professional Development Programs by the Australian Medical Council. May 2013 4 Burnand Jo. A review of the accreditation framework for prevocational training in NSW. August 2013



• Intern assessment and requirements for general registration; • Accreditation of intern accreditation authorities • Emergence of alternative placements in community, public health and general

practice.

3. The Australian Curriculum Framework for Junior Doctors (ACF) and the Prevocational Medical Accreditation Framework for the Education and Training of Prevocational Doctors (PMAF) by the Confederation of Postgraduate Medical Education Councils (CPMEC).

4. Emerging concerns regarding the burden of accreditation processes at all levels.

The NSW response to the national changes NSW has a well-established program for accrediting terms and programs of prevocational education and training providers at both the PGY1 and PGY2 level. In 2013, in response to the national triggers for change to prevocational education and training accreditation, HETI commissioned a needs assessment for prevocational training accreditation in NSW, which was completed by IECO Consulting. Their report, ‘A review of the accreditation framework for prevocational training in NSW’, contained twenty-two recommendations for change. In 2014 HETI convened an Accreditation and Standards Review Committee to: • Develop and implement a new set of standards for prevocational education and training

in NSW, aligned to the AMC’s national standards for intern training. • Revise the NSW framework for accrediting prevocational training providers (PTP),

prevocational education and training programs and terms in NSW.

This document outlines the accreditation framework for PTPs, programs and terms in NSW. The objectives of HETI’s NSW prevocational training accreditation framework are to: • Outline the legislative and governance framework for prevocational training in NSW • Specify the roles of key stakeholders in prevocational training accreditation in NSW • Provide an overview of the processes for accrediting prevocational training providers,

education and training programs and terms.

In developing this framework, the Committee has been guided by: • A review of the accreditation framework for prevocational training in NSW5 • AMC Intern training – Domains for assessing accreditation authorities.6 • AMC Intern training – National standards for programs7 • ACF Prevocational Medical Accreditation Framework8 • AMC Procedures for assessment and accreditation of intern training accreditation

authorities by the Australian Medical Council.9

5 Burnand Jo. A review of the accreditation framework for prevocational training in NSW. August 2013 6 Australian Medical Council Limited, Intern Training - Domains for assessing accreditation authorities, November 2013. 7 Australian Medical Council Limited, Intern Training – National standards for programs November 2013. 8 Confederation of Prevocational Medical Education Councils. Prevocational Medical Accreditation Framework for the education and training of prevocational doctors.



PREVOCATIONAL EDUCATION AND TRAINING PROGRAM

Good quality prevocational education training programs (PETP)10 will have the following outcomes:

• Provide trainees with the knowledge, skills and supervision to enable them to provide safe and quality patient care

• Provide a wide range of educational and training opportunities which develop safe and competent trainees

• Promote and advocate for trainees’ career development and welfare.

For the PETP to be successful in delivering these outcomes, it needs to function in an optimal learning environment. The components of the optimal learning environment have been identified by Dr Jo Burnand in her report on The Review of the Accreditation Framework for Prevocational Training in NSW 5.

The components of the PETP are outlined in Figure 1 below:

Figure 1 Prevocational Education and Training Program 11

9 Australian Medical Council. Procedures for Assessment and accreditation of Intern Training Accreditation Authorities by the Australian Medical Council. November 2013. 10 Health Education and Training Institute, Standards of Education, Training and Supervision for Prevocational Training and Post AMC supervised training Version 4.4. September 2011 11 HETI Version 4, February 2014, General Practice Prevocational Education and Training Standards for general practices and general practice supervisors.



LEGISLATIVE AND GOVERNANCE FRAMEWORK The Medical Board of Australia (MBA) registration standard for granting general registration to medical graduates from an Australian Medical Council (AMC) university requires the postgraduate year 1 (intern) training terms to be accredited against approved accreditation standards, by an authority approved by the MBA.12 HETI is accredited by the AMC as the NSW intern accreditation authority. HETI’s accreditation status is reviewed regularly through a process of annual review and periodic assessment by the AMC. As an AMC-accredited authority, HETI is responsible for ensuring the prevocational training and education providers whom it accredits, comply with the AMC’s national standards for intern training programs and terms and HETI’s corresponding standards for prevocational education and training programs and training providers in NSW. In the 2013-2015 Service Compact between HETI and the Ministry of Health, HETI’s accreditation functions were expanded to include the establishment of standards and accreditation of prevocational training providers and their programs. HETI’s NSW prevocational training accreditation program scope includes all postgraduate year 1 and year 2 (PGY) prevocational trainees employed by NSW Health. The delivery of the prevocational education and training program (PETP) is the responsibility of the prevocational training providers (PTP) in health facilities. 13 The PTPs are not permitted to provide training to their prevocational trainees until their PETP and each clinical term have been accredited by the HETI Prevocational Accreditation Committee.

STAKEHOLDERS IN THE ACCREDITATION PROCESS

HETI HETI’s primary role in accreditation is to focus on achieving the objectives of prevocational training accreditation, maintain the currency of the prevocational education and training accreditation standards and monitor the effectiveness of the accreditation program, so that PTPs in Local Health Districts provide PGY1s and PGY2s with high quality education and training and enable PGY1 to obtain general registration with the Medical Board of Australia.

Prevocational Accreditation Committee (PAC) The HETI Prevocational Accreditation Committee (PAC) oversees the accreditation of prevocational education and training programs and training providers. It does this by setting an annual program of accreditation activities, through which it advises HETI and makes recommendations on ongoing compliance by education and training providers. The Terms of Reference and Membership of the PAC are available on the HETI website.

12 Medical Board of Australia. Registration Standard. Granting general registration as a medical practitioner to Australian and New Zealand medical graduates on completion of intern training. 2014 on http://www.medicalboard.gov.au/Registration-Standards.aspx 13 Recommendation 1. Burnand Jo. A review of the accreditation framework for prevocational training in NSW. August 2013.



Prevocational Training Providers A prevocational training provider (PTP) is a legally recognised organisation that governs and/ or provides some or all aspects of a prevocational education and training program (PETP). These include a hospital (public or private), community health setting, general practice or a Prevocational Training Network comprising a number of facilities. Facilities/Networks providing prevocational training need to meet HETI’s prevocational training standards for accrediting training providers, programs and terms. These standards cover the functional areas of governance, education and training and trainee welfare. For a full description of the Standards refer to ‘HETI Prevocational education and training standards for health services (June 2014)’.

Prevocational trainees It is essential that prevocational trainees have an opportunity to contribute to the assessment and accreditation of prevocational education and training programs 14 . As such, trainee involvement and membership are an integral part of all HETI and training provider committees and survey teams, as well as having the opportunity to contribute individually to the accreditation process.

THE PREVOCATIONAL TRAINING ACCREDITATION FRAMEWORK Prevocational training accreditation The objective of the prevocational training accreditation process, managed by HETI, is to ensure that prevocational education and training programs promote and protect the safety and quality of patient care by effectively training good quality clinicians. Accreditation is more than just quality assurance; it involves continuous quality improvement of training programmes in order to respond to evolving community need and professional practice.15

Quality patient care is promoted by setting objective standards for prevocational education and training programs, assessing the prevocational training providers who provide these programs and undertake assessment and supervision of the prevocational trainees against these standards.

The following principles underpin the prevocational training accreditation process:

• Provide clear governance structures at HETI, Network and facility level; • Balance the regulatory and quality assurance function of accreditation;

14 Australian Medical Council Limited. Procedures for assessment and accreditation of intern training accreditation authorities by the Australian Medical Council

15 Australian Health Practitioner Regulation Agency. Quality framework for the accreditation function, 2011



• Update the accreditation frameworks to reflect evolving best practice to measure both the optimum learning environment and training program outcomes;

• Encourage innovation and focus on recognizing excellence rather than having a unilateral focus on issue identification and areas for improvement;

• Ensure trainees and trainers are a valued source of information and are engaged in the accreditation review processes;

• Promote best practice through cyclic accreditation and peer review processes; • Review progress in implementing recommendations and conditions through site visits; • Ensure that processes are streamlined, flexible and adaptable to measure training

across a range of settings including hospital, community and general practice; • Demonstrate transparency by public reporting of facility training provider’s accreditation

status on HETI’s website.16

Scope of accreditation This Framework applies to all PTPs and their PETPs that are or wish to be accredited by HETI. The service compact between HETI and NSW Ministry of Health17 ensures PTPs who train NSW Health prevocational trainees have access to a prevocational accreditation authority. All successful PTP accreditations by HETI are based on the PTP demonstrating that it meets or substantially meets the requirements specified in HETI’s NSW Prevocational Education and Training Standards. Accreditation of prevocational education and training programs is moving from a 3 year to a 4 year accreditation period, with the exception of rotating hospital terms.

Levels of accreditation There are two levels of accreditation a Prevocational Training Provider can obtain: 1. Home hospital prevocational training provider

A Home Hospital prevocational training provider can provide training to a prevocational trainee for ten terms of a prevocational trainee’s PGY1 and PGY2 year. In rare circumstances some of these terms may be provided at another hospital.It has a primary caretaker role in relation to their hospital orientation and the prevocational trainee’s general registration as a medical practitioner and the organisational structures to support the PETP For a more detailed description of the home hospital role in relation to the trainee and the prevocational education and training program organisational structures, refer to the HETI prevocational training accreditation procedure.

16 Burnand Jo. A review of the accreditation framework for prevocational training in NSW. August 2013 17 NSW Ministry of Health. A compact between: Director- General, Ministry of Health and Health Education and Training Institute for the period 1 July 2013- 30 June 2015. 2013



2. Rotational prevocational training providers (a) PGY 2 only and (b) PGY1 & 2 A Rotational prevocational training provider can only provide training to prevocational trainees for a maximum of three out of the five terms of a prevocational trainee’s PGY1 and PGY2 year. A PGY2 only prevocational training provider is limited to offering training only to trainees in their second postgraduate year. A rotation prevocational training provider is responsible for a prevocational trainee’s education, training, supervision, assessment, safety and welfare when they are at the rotational training facility.

The Accreditation process HETI accreditation’s program is cyclical and involves accreditation of individual clinical terms, a prevocational education training program (PETP) and the prevocational training provider (PTP). The accreditation process consists of: • The prevocational training provider’s self-assessment; • Peer review survey or focus visit as organised by HETI; • Prevocational accreditation committee accreditation decision; and • Ongoing monitoring of the PTP to ensure standards continue to be met.18. The full period of reaccreditation for prevocational training providers in NSW will be four years19. This aligns with the AMC’s requirements for intern accreditation authorities.20

Types of assessments HETI will assess prevocational training providers (PTP) in the following circumstances: 1. New applications:

(a) new prevocational training terms or programs (b) significant changed circumstances in existing prevocational training terms and

programs (c) notified departure from the standards within a term or program

2. Reaccreditation

3. Where HETI requires follow up action due to:

(a) a limited period of accreditation being granted (b) conditions being placed on the accreditation

18 Recommendation 8 & 20. Burnand Jo. A review of the accreditation framework for prevocational training in NSW. August 2013 19 Recommendation 7 Burnand Jo. A review of the accreditation framework for prevocational training in NSW. August 2013 20 Page 4, Australian Medical Council Limited, Intern Training - Domains for assessing accreditation authorities, November 2013.



Assessment can take the form of: • A documentation review assessed by the Prevocational Accreditation Committee (PAC),

and/or • Interviews with relevant parties by PAC members, and/or • Trainee feedback, and/or • a site visit assessed by an accreditation survey team who prepare a report for the PAC.

Process for assessing new applications

The process for accrediting a term is outlined in Figure 2 below:

Figure 2 Term Accreditation 21

21 Burnand Jo. A review of the accreditation framework for prevocational training in NSW. August 2013

Provider identifies a new term or term that needs modification

Provider completes application form for new and modified terms

Form submitted to HETI

HETI program staff checks information complete

Application assessed by PAC member

Does the term meet requirements? YES

NO

Term provisionally accredited

Seek further documentation and information from provider

Referred to PAC for further consideration



Process for prevocational training provider re-accreditation

Figure 3 below outlines the pre-review process for existing prevocational training providers seeking re-accreditation:

Figure 3 Pre-review process 22 The review process (A) is outlined in Figure 4 below:


Provider completes self-assessment

Information electronically submitted to HETI

Information reviewed by survey team

Have any significant

issues been identified?

Planned visit to complete random sample and review initiatives (A)

PRE-REVIEW

YES NO

Collated trainee survey data

Self-assessment Submissions

Work undertaken with provider to prepare for

focused review visit Planned visit to focus

on identified issues (B)

Other evidence



Review process

Figure 4 Review process

Prevocational training accreditation rating system The accreditation rating system is a three point scale and each standard is mandatory:

Low Achievement (Standard not met)

The PTP fails to meet the standard because either it has not demonstrated compliance with critical criteria* within a standard, or lack of compliance with a majority of criteria.

Moderate Achievement (Standard met)

The PTP has demonstrated it has met the standard by compliance with most criteria, including those considered to be most critical.

Extensive achievement (A leader)

The PTP has demonstrated compliance with a standard to a higher than average level, through innovation and leadership.

HETI team visit provider

HETI team rate provider against the standards

REVIEW (A)

Interviews Documentation review Focus on identified issues

HETI team prepare preliminary findings and

debrief provider



* Critical criteria are those criteria within the accreditation standards, which are considered mandatory for the prevocational training provider to meet to a minimum level for both accreditation and re-accreditation purposes if seeking four year accreditation from HETI.

Accreditation conditions When there has been a significant failure to meet of one or more of prevocational training standards, the Prevocational Accreditation Committee (PAC) will place one or more ‘conditions’ of prevocational training provider’s (PTP) accreditation status. The ‘conditions’ are actions that must be completed by the PTP to rectify the failure to meet the standard. Where multiple conditions are indicated following an assessment survey or training provider progress report, a reduced accreditation period may be considered. When the conditions are addressed, the accreditation status of the provider will be reviewed. For more details on Conditions see HETI Prevocational Training Accreditation Procedure.

Accreditation recommendations

Where there are aspects of a prevocational education and training program that could be improved by the training provider from a systems management viewpoint, the survey team leader will include recommendations for action in the survey report. The Prevocational Accreditation Committee (PAC) will consider the recommendations in the draft report and these may be modified in the final report that is issued to the prevocational training provider.



The post accreditation review process

The post accreditation review process is outlined in Figure 5 below:

Figure 5 Post review process23


HETI survey team submits report to PAC

PAC awards up to 4 years

POST REVIEW

Report reviewed by the PAC

PAC considers information and determines appropriate action

Have any significant issues been identified?

YES NO

Provider takes action

PAC considers action taken by provider

Is appropriate action being taken to address

identified issues?

YES

NO

Providers supply an annual

progress report

HETI survey team draft report sent to provider for identification of technical inaccuracies

HETI survey team finalises report after consideration of PTP’s feedback



Response options to the Assessment Report The prevocational training provider can choose to:

• Accept the Assessment Report • Ask the Committee to consider minor changes • Ask the Committee to consider a significant change to the Report and or

recommendations through the HETI formal accreditation reconsideration process. For further information on the response options to the Assessment Report and for reviews of accreditation decisions, see the HETI Prevocational Training Provider Accreditation

Assessment of departure from the standards HETI will respond to any concerns raised about the education and training of prevocational trainees made by an identifiable individual. These concerns can be reported through different sources including trainees or their advocates, health care staff or management. The concerns can include issues relating to the quality of the education and training provided to trainees, patient and trainee safety concerns, and management of the training program.

Accreditation options for prevocational training programs Options for accrediting an established prevocational education and training program include:

• Accreditation of the education and training program in its entirety. • Accreditation of only some aspects of the education and training program. For

example, it may accredit all or only some terms. • Accreditation of the education training programs without conditions imposed on the

provider. • Accreditation of the education and training program with conditions imposed on the

prevocational training provider, where the continuing accreditation of the program is subject to the training provider satisfying these conditions within the set timeframe.

Each provider will undergo an accreditation assessment by HETI at least every four years. Following an onsite assessment, HETI can grant accreditation up to a maximum period of four years. Where the PAC, refuses or revokes program accreditation, the provider may reapply for accreditation. However, it must first satisfy the Committee it has the capacity to address the concerns raised by PAC that resulted in the change of accreditation status. For further information on accreditation options available for prevocational training providers, see: HETI Prevocational Training and Accreditation Procedure



Monitoring accredited prevocational training programs Once HETI accredits a prevocational education and training program (PETP), HETI monitors the prevocational training provider (PTP) to ensure it continues to meet the HETI standards.

Methods for monitoring PTP compliance with accreditation standards The main monitoring mechanism for the PETP is reviewing PTP structured progress reports. The PTP is required to report matters that may affect the accreditation status, such as capacity to meet the standards or a major change or development. HETI may also solicit feedback from trainees, provider staff as well as request further information as required from the PTP. The prevocational training provider monitoring process is outlined in Figure 6 below.

Figure 6 Prevocational training provider monitoring process24


Provider upload agreed data set*

Information electronically submitted to HETI

HETI program staff review information

Are there any emergent concerns?

Yes No

Program staff work with provider to seek further information

Referred to PAC for further consideration

Prevocational trainee survey

Does the issue warrant consideration by the PAC?

Yes

No

*Data set includes: - Annual progress report - GCTC minutes - Network minutes - Collated trainee feedback - Other data sets

Submissions



Processes for managing unsatisfactory progress of PTP

If HETI, on the basis of progress reports or other advice, considers the PTP and PETP may no longer meet the standards or will have difficulty in the future, further investigation may occur, using processes such as a focus visit. Depending on the investigation findings, this may lead to modification of the provider’s accreditation status, including revocation of accreditation if required.

Advisory Groups

There are circumstances where PTPs, both existing and new applicants, may require additional advice on accreditation requirements. With the agreement of the training provider, the PAC may establish an Advisory group to work with the PTP to clarify the accreditation requirements which need to be satisfied and advise and assist the provider in meeting them.

Public Reporting HETI will place the following information concerning the accreditation status of prevocational training providers and their programs on its website25:

• The current status and accreditation history of the accredited training provider and their programs, clinical terms and date of next accreditation assessment.

• The Executive summary of the PTP’s most recent accreditation report. An annual summary of the PAC’s responses to the PTP progress reports.

HETI’s accreditation reports are public documents.

Review of standards and accreditation procedures The process for reviewing standards and accreditation procedures provides an opportunity for all stakeholders to contribute to the review and for HETI to build on the experience of its Prevocational Accreditation Committee and improve its accreditation survey processes. HETI gathers feedback on the accreditation process from the following sources: • Each prevocational training provider, following their accreditation assessment • HETI staff submitting agenda items concerning interpretation of the accreditation

standards to the Prevocational Standards Accreditation Committee • The HETI Accreditation Survey Team Leader regarding the PTP assessment process • HETI staff log of procedural changes needed and the dates when each procedural

change has been completed reported to the PAC Committee HETI reviews the full set of its prevocational training accreditation standards for assessing the PTPs whenever there are significant state or national developments and reviews all procedures as required.

25 Recommendation 12. Burnand Jo. A review of the accreditation framework for prevocational training in NSW. August 2013



HETI accreditation survey teams

The HETI staff will establish an accreditation survey team when required to assess a prevocational education and training provider and the provider’s training program. Teams will include diverse professional representation including JMO representation to enable them to provide an effective peer review of the structure and quality of the training programme. Procedures

HETI has developed procedures and documentation in relation to the various components of the prevocational education and training accreditation process26. These procedures address: • Application, reaccreditation and change of status • Complaints and Appeals • Change in circumstances • Conducting review visits - timing, team composition, length of survey • Conflict of interest • Confidentiality • Departure from the standards • Evaluation and review of the accreditation system • Management of the accreditation system • Supervision • Classification policy • Surveyor recruitment, training and management • Transparency and dissemination of information

26 Confederation of Prevocational Medical Education Council. Prevocational Medical Accreditation Framework for the education and training of prevocational doctors. 2009.



REFERENCES Australian Health Practitioners Regulation Authority. Quality Framework for the Accreditation

Function Framework, Australian Health Practitioners Regulation Authority, 2011.

Australian Medical Council Limited. 'Intern Training - Domains for assessing accreditation authorities'. 2013.

Australian Medical Council Limited. Procedures for assessment and accreditation of Intern Training Accredittion Authorities by the Australian Medical Council. Procedure, Australian Medical Council Limited, 2013.

Australian Medical Council Limited. 'Procedures for assessment and accreditation of specilist medicla education training programs and professional development programs by the Australian Medical Council.' 2013.

Burnand, Jo. A review of the accreditation framework for prevocational training within NSW. review, IECO consulting, 2013.

Confederation of Prevocational Medical Education Councils. 'Prevocational Medical Accreditation framework for the education and training of prevocational doctors.' Framework, 2009.

Health Education and Training Institute. A framework for accrediting prevocational medical education, training and supervision in general practice settings. Framework, Health Education and Training Institute, 2010.

Health Education and Training Institute. 'General Practice Prevocational Education and Training Standards for General Practice and General practice Supervisors. Version 3.' Standards, 2011.

Health Education and Training Institute. General Practice Prevocational Education and Training Standards for Regional Training Providers. Standards, Health Education and Training Institute, 2011.

Health Education and Training Institute. 'Standards of Education, Training and Supervision for Prevocational Training and Post AMC Supervised Training Version 4.4.' Standards, 2011.

Health Education and Training Institute. Prevocational General Practice Placement Program Interim Accreditation Process. Guide, HETI, 2012.

Australian Medical Council Limited. 'Intern training - National Standards for programs.' 2013.

Medical Board of Australia. 'Registration Standard. Granting general registration to Australian and New Zealand medical graduates on completion of intern training'. Standard, 2014.

NSW Ministry of Health. Service Compact. A compact between: Director- General, Ministry of Health and Health Education and Training Institute for the period 1 July 2013-30 June 2015. Contract, NSW Ministry of Health, 2013.

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