For International Medical Graduates (IMGs) aspiring to practice medicine in Australia, the Pre-employment Structured Clinical Interview (PESCI) is a critical step. This comprehensive guide provides essential information to help you navigate the PESCI examination process successfully.

The PESCI is administered by three accredited providers:

• Australian College of Rural and Remote Medicine (ACRRM)
• Royal Australian College of General Practitioners (RACGP)
• Institute of Medical Education (METC Institute)

Purpose of the PESCI

The PESCI serves as a critical checkpoint, ensuring that IMGs possess the necessary knowledge, skills, clinical experience, and attributes to deliver safe and effective medical care to Australian patients. This assessment reflects the paramount importance placed on patient safety and the quality of healthcare in the nation. The involvement of multiple accredited providers, all overseen by the Australian Medical Council (AMC), ensures consistent standards in the evaluation process. However, IMGs should be aware that subtle variations in interview format or areas of emphasis might exist between these providers.

The primary purpose of the PESCI is to objectively evaluate an IMG’s suitability for a specific medical position within the Australian healthcare context. This evaluation focuses on the IMG’s capacity to practice medicine safely and effectively, adhering to Australian medical standards and regulations. A key point to understand is that the PESCI is position-specific. The outcome of an interview conducted for one particular job offer is generally not transferable to another position. This necessitates that IMGs undertake a PESCI tailored to each specific job they are offered. This emphasis on a particular role underscores the importance for IMGs to thoroughly understand the requirements and context of the job they are applying for, ensuring their preparation aligns with the specific demands of that position. Furthermore, the PESCI is not merely an assessment of theoretical medical knowledge. Instead, it is designed to evaluate the practical application of skills in realistic clinical scenarios, focusing on whether the IMG “knows how” to apply their knowledge in a patient care setting, rather than simply possessing the knowledge itself.

Who Needs a PESCI?

Generally, IMGs on the Competent Authority or Standard pathway who are seeking provisional or limited registration to work in general practice in Australia are required to undergo a PESCI. However, there are specific exemptions. Specialist IMGs applying through the Specialist pathway or the Expedited Specialist pathway are typically not required to sit for the PESCI, as their qualifications are assessed by the relevant specialist medical colleges. A slightly different process applies to IMGs seeking limited registration for an area of need to work in general practice. These applicants must possess a minimum of three years of full-time equivalent (FTE) experience in general practice or primary care. AHPRA advises these individuals to apply for registration first, allowing the Medical Board to assess their experience before a PESCI is arranged. If the experience requirement is met, a PESCI will then be necessary before the registration application can be processed. Ultimately, the Medical Board of Australia retains the authority to determine whether a PESCI is required in any given situation, considering the specific nature of the position and its inherent level of risk. The Competent Authority pathway, which allows some IMGs to gain registration without sitting the AMC exams, often necessitates a PESCI for those seeking general practice roles. This suggests that the PESCI serves as a crucial assessment of clinical competence for this group. The differing advice on when to arrange a PESCI for the “area of need” registration highlights the importance of IMGs carefully reviewing the specific requirements for their intended registration type and consulting the official websites of the Medical Board and AHPRA early in their application process.

Eligibility for the PESCI

To be eligible for the PESCI, candidates generally need to have passed the Australian Medical Council (AMC) Computer Adaptive Test Multiple Choice Questionnaire (CAT MCQ) Examination or qualify for the Competent Authority pathway. Additionally, they must hold a primary medical qualification that is listed in the World Directory of Medical Schools (WDOMS). A valid job offer in Australian general practice is also a fundamental requirement for undertaking the PESCI. For those applying through ACRRM, a specific PESCI eligibility checklist is available as a resource. It is essential to note that all applicants must meet the overarching registration requirements stipulated by the Medical Board of Australia before they can apply for a PESCI. The prerequisite of passing the AMC MCQ or being eligible for the Competent Authority pathway indicates that a foundational level of medical knowledge is expected before the PESCI, which then focuses on evaluating the practical application of this knowledge in clinical settings. Furthermore, the requirement of a job offer underscores that the PESCI is an assessment of an IMG’s “fitness for task” within a specific role, rather than a general evaluation of their overall medical competency.

Structure of the PESCI

The PESCI is structured as a clinical interview that utilizes a series of clinical case scenarios to assess the candidate’s abilities. This interview is typically conducted by a panel comprising at least three members, including registered medical practitioners and potentially a community member or another healthcare professional. For candidates undertaking the PESCI with RACGP, the interview usually involves five clinical scenarios. For each scenario, candidates are given reading time to understand the case, followed by a designated period to answer a series of questions related to the patient’s presentation. The interviewers assess the candidate across various domains, including their medical interviewing skills, physical examination skills (often assessed through discussion in an online format), clinical judgment, approach to treatment and providing advice, communication skills, and professionalism. Depending on the specific position, procedural skills and other relevant domains might also be evaluated. Notably, ACRRM conducts its PESCI assessments via video conference using platforms like Zoom. Candidates preparing for the RACGP PESCI can find more detailed information about the interview format in the RACGP PESCI Handbook. The structured format and the use of standardized scenarios aim to ensure objectivity and consistency in the assessment process, allowing for a fair comparison of candidates across different providers and interview panels. The comprehensive assessment across multiple domains emphasizes a holistic evaluation, considering not only the IMG’s clinical knowledge but also their essential interpersonal skills and professional conduct, which are vital for effective and patient-centered care within the Australian healthcare system.

The PESCI Registration Process

The registration process for the PESCI involves several steps, which can vary slightly depending on the chosen provider.

For RACGP, the process typically includes:

1. Securing a suitable position in Australian general practice.
2. Applying to the AMC for primary source verification of medical qualifications.
3. Obtaining an RACGP ID to access the online application form.
4. Submitting the online application with required documents:
   • Curriculum vitae (CV) using the RACGP template
   • Name change documentation (if applicable)
   • Evidence of passing the AMC CAT MCQ Examination
   • Proof of current medical registration
   • Detailed position description on the RACGP template
   • AHPRA supervised practice plan and supervisor’s agreement (SPPA-30)
   • Signed PESCI applicant declaration
   • Certified translations of non-English original documents
5. Payment of the interview fee.

For candidates applying through ACRRM, the application is submitted online via the ACRRM website, and they have their own specific documentation requirements.

METC Institute’s registration process involves an eligibility check, followed by purchasing and submitting the application online, an application review by IME, and finally, the scheduling of the PESCI.

Regardless of the provider, it is crucial for IMGs to thoroughly review the specific policies and handbooks provided by their chosen organization to ensure they meet all requirements. The processing times for applications and the scheduling of interviews can vary between the providers, so applicants should factor this into their planning. The requirement for primary source verification of medical qualifications through the AMC’s Electronic Portfolio of International Credentials (EPIC) system highlights the importance of ensuring the authenticity and validity of the IMG’s credentials. This step underscores the rigorous approach taken to verify the qualifications of international medical graduates seeking registration in Australia. The multi-stage registration process emphasizes the need for IMGs to be meticulous in their preparation and to adhere strictly to the guidelines and deadlines set by their chosen PESCI provider.

PESCI Preparation Resources

A wealth of resources is available to assist IMGs in preparing for the PESCI examination. Both RACGP and ACRRM provide official handbooks and guidelines that offer detailed information about the exam format, content, and assessment criteria. ACRRM also offers an online preparation module designed to help candidates understand the PESCI process. While a specific RACGP tutorial link was found to be inaccessible, candidates should check the RACGP website for any updated preparation materials. Numerous third-party organizations, such as IMGSOS, PassGP, ARIMGSAS, and LearnMedicine, offer practice questions, workshops, and comprehensive courses tailored to the PESCI. For example, IMGSOS provides mock PESCI interviews and personalized feedback. PassGP offers scenario-based learning modules and exam-style questions. ARIMGSAS focuses on communication skills and cultural sensitivity training relevant to the Australian healthcare context.

LearnMedicine offers a comprehensive suite of PESCI preparation courses designed to equip IMGs with the knowledge, skills, and confidence needed to excel in this crucial assessment. Our expertly crafted programs go beyond simply covering the exam content; they provide targeted practice in realistic clinical scenarios, personalized feedback from experienced medical educators, and in-depth guidance on navigating the specific challenges of the PESCI. With LearnMedicine, you’ll gain a thorough understanding of the Australian healthcare system, refine your clinical reasoning and communication skills, and develop effective strategies for managing the interview process. Our courses also offer valuable insights into the cultural nuances of Australian medical practice, ensuring you’re well-prepared to demonstrate cultural sensitivity and patient-centered care.

Additionally, IMGs can benefit from utilizing resources provided by the Australian Health Practitioner Regulation Agency (Ahpra), the Australian Medical Council (AMC), and the Medical Board of Australia (MBA), as these organizations set the overall standards and guidelines for medical registration. Reviewing the RACGP Curriculum for Australian General Practice and familiarizing oneself with guidelines on common medical conditions encountered in Australia, such as those from the National Health and Medical Research Council (NHMRC), can also be highly beneficial. Engaging with online communities and peer support groups can provide valuable opportunities to share experiences and gather preparation tips from other IMGs who have gone through the PESCI process. The sheer volume of available preparation resources underscores the significance and perceived challenge of the PESCI, highlighting the importance for IMGs to actively seek out and utilize these materials to enhance their chances of success. The specific mention of resources focusing on the Australian healthcare context, including cultural awareness related to Aboriginal and Torres Strait Islander health, emphasizes the need for IMGs to adapt to the local healthcare system and demonstrate cultural sensitivity during the assessment. This implies that preparation should include familiarizing oneself with Australian healthcare practices and cultural nuances.

PESCI Scoring

The PESCI scoring system typically involves a rating scale, often ranging from 1 to 5, for each of the assessed domains. A rating of 3 generally indicates that the candidate’s performance in that domain is suitable for the position. The different rating levels provide a nuanced assessment of the candidate’s abilities, ranging from “highly suitable” (5) to “unsuitable” (1). The common domains that are assessed include medical interviewing skills, physical examination skills, clinical judgment, approach to treatment and providing advice, communication skills, and professionalism. Depending on the specific role, other domains such as procedural skills might also be evaluated. Following the interview, the panel of assessors provides an overall recommendation regarding the candidate’s suitability for the specific position they have applied for. The outcome of the PESCI is usually communicated to the candidate via email within a specific timeframe, which can vary slightly between providers. For example, RACGP aims to send the outcome report within 15 business days, while ACRRM typically takes 14 to 21 days, and METC Institute aims for 14 business days. A copy of the PESCI report is also sent directly to the Medical Board of Australia (MBA) for their consideration in the registration process. While the numerical ratings for each domain provide valuable feedback, the overall recommendation from the PESCI panel carries significant weight in the Medical Board’s final decision regarding medical registration. Therefore, IMGs should strive for a consistently good performance across all assessed domains. The feedback provided in the outcome report, particularly for candidates who are deemed unsuitable, offers crucial insights into areas that need improvement for future attempts or for professional development. It is essential for IMGs to carefully review this feedback and address any identified weaknesses before considering reapplication.

After the PESCI

Upon successful completion of the PESCI, the IMG can proceed with their application for medical registration with Ahpra. It is important to remember that the PESCI outcome report typically has a validity period of 12 months from the date of issue. For candidates who are unsuccessful in their PESCI attempt, the option to reapply exists. This can be for the same position or for a different one. However, each reapplication requires the payment of the full PESCI fee. If an IMG has concerns about the outcome or the conduct of their PESCI, they generally have the option to apply for reconsideration, review, or appeal through the provider. In certain circumstances, such as when an IMG has a successful PESCI outcome but then secures a position at a different practice, it may be possible to apply for a PESCI exemption, provided the new position is substantially similar to the one for which the PESCI was originally conducted. The limited validity period of the PESCI outcome emphasizes the need for IMGs to carefully plan their PESCI application in relation to their job offer and the overall registration timeline to avoid the possibility of their result expiring before they can secure registration. The availability of processes for reconsideration and appeal provides a mechanism for IMGs to raise legitimate concerns about their assessment, contributing to the fairness and accountability of the PESCI process. However, it is important to note that these processes often involve fees and specific criteria for application, suggesting they should be pursued thoughtfully and with appropriate justification.

Choosing a PESCI Provider

When choosing a PESCI provider, IMGs should consider several key factors. The three accredited providers are RACGP, ACRRM, and METC Institute. Historically, there have been reports suggesting potential differences in pass rates between these providers, with ACRRM sometimes having a lower pass rate compared to RACGP. However, it is crucial to seek the most up-to-date information on this, as these trends can change. ACRRM has a particular focus on rural and remote medicine, which might be a significant factor for IMGs seeking positions in these areas. RACGP’s examinations are widely recognized internationally, which could be a consideration for some IMGs. METC Institute offers the flexibility of both in-person interviews (in Queensland) and virtual interviews for candidates across all states and territories. Ultimately, IMGs should consider the location and nature of their job offer, the reputation and support resources offered by each provider, and any specific requirements or preferences of their prospective employer when making their choice. The fact that all three providers are accredited by the AMC provides a level of assurance regarding the quality and standards of the PESCI, regardless of which provider an IMG selects.

Provider Name	Focus/Specialization	Interview Modality	Key Resources Offered	Potential Pass Rate Trends (Note: Data may vary; verify current information)	Contact Information
RACGP	General Practice	Online (Zoom)	PESCI Handbook, Applicant Technical Guide, Applicant Introductory Module, Position Description Template, Applicant Declaration Form, CV Template, Policies on PESCI, Collection Notice, Academic Misconduct, Disputes/Reconsideration/Appeals	Historically higher pass rates reported compared to ACRRM	Refer to the RACGP website for contact details
ACRRM	Rural and Remote Medicine, General Practice	Online (Zoom)	PESCI Online Module, PESCI Handbook, General Practitioner Position Description Template, PESCI Candidate Agreement, PESCI Proforma CV, Videoconference Technical Requirements, Reconsideration/Review/Appeals Policy, Training Plan Template, PESCI Application Checklist, PESCI Eligibility Checklist	Historically lower pass rates reported compared to ACRRM	Refer to the ACRRM website for contact details
METC Institute	General Practice	In-person (QLD) or Virtual (All States)	Information on application process, eligibility criteria, cancellation/rescheduling/re-sit policy, review and appeals policy, PESCI FAQ	Pass rate data not readily available in the provided information	Refer to the METC Institute website for contact details

The PESCI is a significant step for IMGs seeking to practice in Australia. It is designed to ensure that IMGs have the skills and knowledge to provide safe and effective care in the Australian healthcare system. IMGs should carefully prepare for the PESCI and select a provider that aligns with their individual needs and career goals.

For IMGs seeking comprehensive preparation for the PESCI, LearnMedicine offers a range of courses designed to maximize your chances of success. Our expertly crafted programs provide targeted practice, personalized feedback, and in-depth guidance to help you excel in the PESCI.