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Specialist Surgical pathway for IMGs

WHAT IS SIMG Specialist Surgical ASSESSMENT?

Specialist assessment is a vital process for Specialist International Medical Graduates (SIMGs) who possess a specialist surgical qualification and wish to practice as specialists in Australia. The process is managed by the Royal Australasian College of Surgeons (RACS), which evaluates the IMGs' training, assessments, experience, recent practice, and ongoing professional development. This evaluation is to ensure that these elements align with the standards of surgeons trained in Australia and New Zealand. RACS conducts assessments in following

• Cardiothroacic Surgery

• General Surgery

• Neurosurgery

• Orthopaedic Surgery

• Otolaryngology Head & Neck Surgery

• Paediatric Surgery

• Plastic & Reconstructive Surgery

• Urology

• Vascular Surgery

If you need help with Surgical SIMG application and interview

Email along with your CV for further clarification

Steps of SIMGS Surgical assessment

The specialist assessment process involves 3 keys steps:

  1. Application interim assessment (which may include document evaluation and/or interviews)

  2. Continuous workplace assessment (like peer reviews or clinical assessments)

  3. Final assessment decision. This process can take up to four years for IMGs to complete, and fees are applicable at each stage.

What is the Area of Need Assessment?

The Area of Need (AoN) assessment is designed for IMGs with a specialist surgical qualification who have secured a position in an officially designated ‘Area of Need’ in Australia. These AoN positions are determined by the respective state or territory health authority. RACS plays no role in defining AoN positions or in helping applicants find them. If an IMG secures an AoN position, they must undergo RACS assessment to be eligible to practice in that role.

For an IMG to be deemed suitable for an AoN position, they must demonstrate recent surgical practice relevant to the AoN position, have favourable specialist assessment results, and complete specific levels of supervision. The RACS also requires that IMGs seeking AoN assessment apply simultaneously for specialist assessment in the relevant specialty.

Eligibility Criteria for Assessment

To apply for specialist assessment with RACS,

  • an applicant must have completed specialist training overseas (5 year training program + Pass in specialist exam which has both theory and clinical components)

  • be recognised as a specialist surgeon in their training country

  • verify their qualifications through the ECFMG's EPIC and establish an AMC portfolio online.

  • For AoN assessment, an applicant must have been offered a designated AoN position, meet the specialist assessment criteria, and also apply for specialist assessment.



The first phase of the RACS specialist assessment process consists of a document-based assessment. The document-based assessment is an assessment of all the documentation provided by you with your application. It is important that you submit all the documentation relating to the items listed in the online application form, and any additional information that you think may be relevant to your application. Once your application is received via our online application system, the RACS will undertake a review of the documentation you have submitted to ensure your application is complete. If the documentation appears to be incomplete, the RACS will contact you directly by email.

The factors considered are:

• Recency of practice

• Education and training program completed

• Exit examination completed;

• Quantity, depth and scope of practice since completion of training

A recommendation will be made on the basis of documentation received and/or interview. The document-based assessment will involve assessments by the RACS Clinical Director for IMG Assessments and Support, and Specialty Chair or nominee of the relevant Specialty Board. The recommendations which may arise from the document-based assessment include:

• You are required to attend interview within 6 months to finalise your assessment.

• You are Not Comparable and are required to undertake further training.



If you are required to attend a face-to-face interview to finalise your assessment, this constitutes the second phase of the assessment process. The purpose of the interview is to explore specific aspects of your surgical practice, for example, your professional communication skills, your ability to evaluate your surgical practice and your professional ethics. You will have an opportunity during the interview to demonstrate your views and knowledge on these issues by responding to a series of standardised questions, and one or two brief written hypothetical ‘scenarios’. In addition, the interview provides the Assessment Interview Panel with an opportunity to further explore and clarify any aspect of your surgical training and education, and your professional experience and practice, as outlined in the documentation you have provided. The interview also provides you with an opportunity to ask any questions. The Assessment Interview Panel will be seeking to assess how well prepared you are to practise as a specialist in Australia. The interview process will take approximately one hour and 15 minutes, which involves a pre-briefing amongst panel members, the interview with the applicant and post-interview deliberations amongst panel members.

The members of the Assessment Interview Panel comprise:

• The Specialty Chair and/or IMG Representative of the relevant Specialty Board

• A representative from the Board of Surgical Education Training (BSET)

• A jurisdictional or community representative

How to prepare for your interview

There will be a waiting period for your interview. The RACS schedules interviews 6 times a year, February, April, June, August, October and December. The IMG Department will contact you to advise you of the next available interview date.

The interviewers will prepare questions based on the information you have provided in your application.

Questions may cover the following areas:

• basic or core training, advanced or specialist training

• specialist practice

• participation in continuing professional development

• your quality assurance practices

• attainment of higher qualifications

• contributions to the field of surgery Interviewers will assess your competency taking into consideration your technical clinical skills and the non-technical professional attributes described in the RACS Competencies and other professionalism and performance guidelines available on the RACS website


Comparability outcomes

The Assessment Interview Panel will make an Interim Recommendation concerning your comparability with an Australian or New Zealand trained surgeon. The classifications which arise from the documentary assessment and interview are as follows:

Not comparable

If you are deemed Not Comparable, you are required to undertake further training and therefore will need to liaise with the AMC to obtain general registration. Once you have obtained general registration and permanent residency, you will be eligible to apply to the RACS Surgical Education and Training Program (SET). If you are successful in obtaining a place on the SET program, the relevant Specialty Board may shorten the duration of training required according to your progress in accordance with the RACS Recognition of Prior Learning policy.

Partially comparable

If you are deemed Partially Comparable, you will be required to undertake a period of up 24 months of assessment of clinical practice, completion of upskilling/courses and sit and pass the Fellowship Examination as recommended in your Interim Recommendation.

Substantially comparable

If you are deemed Substantially Comparable, you will be required to undertake a period of up to twelve months of assessment of clinical practice and completion of upskilling/ courses as recommended in your Interim Recommendation. You will not be required to sit the Fellowship Examination.

It is useful for you to have a good understanding of the RACS Surgical Education Training program to demonstrate how your training, assessment and experience compare. You should familiarize yourself with the RACS comparable specialist surgical training and exit examination policy applicable to your specialty.



If you proceed with the specialist assessment your next step will be to obtain a hospital position that is suitable for conducting the assessment of your clinical practice. It is your responsibility to find a suitable position. The College highly recommends that you refer to the Doctorconnect website ( where you will find information concerning specialist recruitment agencies that may be able to assist you in finding a suitable position. You need to ensure that the position you are seeking for clinical assessment purposes provides:

•appropriate scope of work

•the appropriateness of the designated Fellows to provide clinical assessment

•opportunities for continuing education and preparation for Fellowship Examination (if applicable).

•the suitability of infrastructure for clinical assessment


The requirement to undertake a period of assessment of clinical practice is made by the Assessment Interview Panel as part of the Interim Recommendation. Assessment of clinical practice may be undertaken on-site or off-site, either by Level 3 Supervision or by Level 4 Supervision.

Understanding Level 4 Supervision for International Medical Graduates (IMGs)

What is Level 4 Supervision?

Level 4 Supervision is a specific type of oversight used in Australia for International Medical Graduates (IMGs), particularly those in surgical fields. It's designed for IMGs who are quite independent but still new to the Australian healthcare system.

Key Features

- Autonomy: IMGs work independently, taking full responsibility for their patients.

- Performance Monitoring: Ensures IMGs' skills are on par with local Australian and New Zealand surgeons.

- Support and Integration: Helps IMGs adapt to the Australian health system and connects them with experienced surgeons for guidance.

Supervision Requirements:

- Regular Reviews: A clinical assessor periodically checks the IMG’s surgical practices.

- Accessible Support: Clinical assessors must be available for consultations.

- Flexible Assessment Methods: Assessments can be conducted on-site by local surgeons or off-site by external surgeons.

  • During Level 4 Supervision, clinical assessors evaluate whether the IMG is performing at the level expected of a surgeon trained in Australia and New Zealand. This involves regular meetings and direct oversight of the IMG’s clinical practice.

Opportunities for IMGs:

IMGs under Level 4 Supervision can undertake clinical assessments in approved Area of Need (AoN) positions, fostering their development and integration into the local healthcare community.

This system, endorsed by the Royal Australasian College of Surgeons, ensures both the quality of care provided by IMGs and their successful integration into the Australian medical community.

What is Level 3 Supervision?

Level 3 Supervision is a structured review process in Australia, specifically designed for International Medical Graduates (IMGs) who are in the surgical field but have limited independence.

- Primary Responsibility: IMGs are primarily responsible for their patients.

- Goal: To ensure IMGs have the skills comparable to surgeons trained in Australia or New Zealand.

- On-Site Supervision: Focuses on quality of clinical practice and overall progress.

Requirements for Level 3 Supervision:

- Local Supervision: This level of supervision must be done in-person (on-site).

- Pathway to Fellowship: IMGs deemed partially comparable are under Level 3 supervision.

- Safety Monitoring: There needs to be a system to regularly check if the IMG is practicing safely through direct observation.

AoN and Level 3 supervision

IMG’s who are required to undertake Level 3 Supervision are not able to undertake clinical assessment in AoN positions unless:

• assessed with a subspecialty scope of practice specific to the AoN position

• 12 months of Level 3 supervision has been satisfactorily completed in a non AoN position and the relevant specialty Board considers the post suitable for completion of the remaining periods of assessment.

• 3 months of level 3 supervision has been satisfactorily completed in a major teaching or tertiary hospital of the relevant specialty and the specialty board considers the post suitable for completion of the remaining periods of assessment

The Supervision Process:

During Level 3 Supervision, clinical assessors regularly meet and directly observe the IMG’s clinical practice. The aim is to evaluate if the IMG has the skills and attributes comparable to a surgeon trained in Australia or New Zealand.

Level 3 and Level 4 Supervision : Responsibilities of supervisors

Clinical assessors providing Level 3 and Level 4 supervision need to:

• ensure that they are accessible by telephone or video link if they are not physically present;

• conduct performance assessment meetings and provide constructive feedback to the IMG;

• complete periodic assessment reports as required by RACS

• address any problems that are identified.

Assessors are expected to liaise with other members of the hospital unit to ascertain the IMG’s performance across all RACS competencies

Further requirements:

Your requirements will also include:

• Completion of IMG orientation eLearning module

• Completion of RACS Operating with Respect eLearning module*

• Participation in the RACS’s Professional Development Activities

• Specified up-skilling in specific areas

• Specific courses or workshops

• Work-based assessment tasks

• RACS Fellowship Examination

• Completion of Fellowship Examination eLearning module

The RACS may require you to complete additional assessments depending on your progress.

PROFESSIONAL DEVELOPMENT ACTIVITIES (PDA) All IMG surgeons undergoing clinical assessment are required to participate in the College’s Professional Development Activities. This program is managed through the College’s Department of IMG Assessments. Further information is available on the College’s website

MAINTENANCE OF PROFESSIONAL STANDARDS (MOPS) An IMG must register for the MOPS program in January of the year following completion of clinical assessment if they have not attained fellowship, and remain in that program until Fellowship is attained or the pathway to Fellowship ceases.


Fellowship Examination is a requirement for IMGs who are assessed as partially comparable to an Australasian trained surgeon.

• the designated period of assessment of professional practice including prescribed professional development activities, and/or

• the Fellowship Examination, and

• verification of both primary and specialist qualifications, and

• advice from the Chair or IMG Representative or relevant specialty Board you would be eligible for Admission to Fellowship of RACS.

Once you have been awarded a Fellowship of RACS or advised by RACS as eligible for Fellowship, you can apply to the Medical Board of Australia for specialist registration.

The RACS will provide a report (MBA Report 2) to AHPRA (via AMC portal) and a copy to you, confirming that you have completed the RACS requirements for specialist recognition and are eligible for specialist registration.

The RACS will also invite you to complete the relevant application forms for Admission to Fellowship. The RACS is not responsible for and cannot assist you with:

• applications for specialist registration

• applications for Medicare provider status.


The RACS specialist assessment and/or Area of Need process normally takes up to 3 months (from date of activation) to complete. Where possible the College will arrange an interview within the specific timeframes outlined above.


The College will advise you of the Interim Recommendation and ask you to notify the College, in writing, of your decision to comply with its requirements. You will have 20 Victorian working days from date of recommendation to respond.

If you are required to undertake a period of assessment of clinical practice under Level 3 or Level 4 supervision, this period of assessment must be commenced within twenty-four months of the Interim Recommendation date; otherwise the Interim Recommendation expires. All elements of the recommendation, including the Fellowship Examination, if applicable, must be completed within four (4) years from the date that the assessment of clinical practice period commences; otherwise the recommendation expires.

IMGs who want to work in New Zealand

If you are an International Medical Graduate with formal postgraduate specialist qualifications, and wish to attain registration to practice as a surgeon in New Zealand, you will need to contact the Medical Council of New Zealand. Medical Council of New Zealand PO Box 11649 Wellington NEW ZEALAND Telephone: +64 4 385 8247 Website:

Complaints and Appeals

The RACS has implemented a formal process for handling complaints and appeals.

These must be lodged within three months of receipt of notice of original decision.

Requests for review or reconsideration of College decision must be lodged in writing and sent to:

The Manager IMG Assessment Department Royal Australasian College of Surgeons 250-290 Spring Street East Melbourne, Victoria, 3002

Complaints or appeals must be lodged in writing and sent to:

The RACS Executive Director of Surgical Affairs Royal Australasian College of Surgeons 250-290 Spring Street East Melbourne, Victoria, 3002

Need Help?

Email along with your CV for further clarification

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