Research Doctorate - Doctor of Philosophy / This thesis explores the barriers that are preventing large numbers of permanent resident overseas-trained doctors (PROTDs) from working as general practitioners (GPs) in rural New South Wales (NSW). It focuses specifically on doctors from non-English speaking backgrounds who are permanent residents of Australia or Australian citizens, and who migrated to Australia for reasons other than employment. This thesis explores the views and perceptions of PROTDs and does not specifically consider the views of other stakeholders. Archival, qualitative and quantitative research techniques have been used to determine the suitability of the policies and practices governing the appointment and registration of PROTDs in NSW, and to identify any policy changes required. This research demonstrates that the policies governing medical registration in NSW have frequently been driven by political factors, and have, at times, been used to control the size of the medical workforce. As a consequence of these policies, many PROTDs have been prevented from working as a doctor in NSW. Of particular concern is the lack of training or clinical experience available to PROTDs and their difficulties preparing for, and passing, the Australian Medical Council (AMC) examinations. The lack of accurate information regarding the requirements and opportunities for medical practice in NSW is also a major problem. PROTDs in NSW are unable to get the training and support they need to meet the requirements for medical registration in NSW and are rapidly losing their confidence, and their clinical skills. Not all PROTDs are going to have, or be able to acquire, the skills and knowledge required for general practice in rural NSW. However the need for additional doctors is sufficiently great to warrant a proactive approach from governments and relevant agencies. In the seven years it has taken to complete this research, most of the discriminatory aspects of the assessment and registration of PROTDs in NSW have been removed. However the legacy of previous policies and practices remains and a large number of PROTDs remain out of the medical workforce.

Research Doctorate - Doctor of Philosophy / This thesis explores the barriers that are preventing large numbers of permanent resident overseas-trained doctors (PROTDs) from working as general practitioners (GPs) in rural New South Wales (NSW). It focuses specifically on doctors from non-English speaking backgrounds who are permanent residents of Australia or Australian citizens, and who migrated to Australia for reasons other than employment. This thesis explores the views and perceptions of PROTDs and does not specifically consider the views of other stakeholders. Archival, qualitative and quantitative research techniques have been used to determine the suitability of the policies and practices governing the appointment and registration of PROTDs in NSW, and to identify any policy changes required. This research demonstrates that the policies governing medical registration in NSW have frequently been driven by political factors, and have, at times, been used to control the size of the medical workforce. As a consequence of these policies, many PROTDs have been prevented from working as a doctor in NSW. Of particular concern is the lack of training or clinical experience available to PROTDs and their difficulties preparing for, and passing, the Australian Medical Council (AMC) examinations. The lack of accurate information regarding the requirements and opportunities for medical practice in NSW is also a major problem. PROTDs in NSW are unable to get the training and support they need to meet the requirements for medical registration in NSW and are rapidly losing their confidence, and their clinical skills. Not all PROTDs are going to have, or be able to acquire, the skills and knowledge required for general practice in rural NSW. However the need for additional doctors is sufficiently great to warrant a proactive approach from governments and relevant agencies. In the seven years it has taken to complete this research, most of the discriminatory aspects of the assessment and registration of PROTDs in NSW have been removed. However the legacy of previous policies and practices remains and a large number of PROTDs remain out of the medical workforce.

This qualitative modified participatory study underpinned by social critical theory explored the experiences of immigrant medical practitioners seeking registration in New Zealand. The occupational science notions of occupation, occupational deprivation and occupational apartheid were used to understand the experiences of the participants. The objective of the study was to understand the experiences of the participants and facilitate their self-empowerment through facilitated dialogue, affording them opportunities for collective action. Data was obtained through in-depth interviews and focus group discussions with eighteen immigrant medical practitioners who were doctors and dentists as well as two physiotherapists. The two physiotherapists were sampled out of necessity to explore diversity in findings. Transcripts were analysed using thematic analysis. This method included the processes of coding data into themes and then collapsing themes into major themes which were organised under categories. Four categories were created in the findings describing the experiences of immigrant practitioners and suggesting solutions. Firstly; findings revealed that immigrant medical practitioners had a potential worth being utilised in New Zealand. Secondly; it was found that these participants faced negative and disabling experiences in the process of being registered. Thirdly; the emotional consequences of the negative experiences were described in the study. Fourthly; there were collectively suggested solutions where the participants felt that their problems could be alleviated by support systems modelled in other Western English speaking countries that have hosted high numbers of immigrant medical practitioners from non-English speaking countries. This collective action was consistent with the emancipatory intent of participatory research informed by social critical theory. This study resulted in drawing conclusions about the implications of the participants’ experiences to well-being, occupational satisfaction as well as diverse workforce development initiatives. This study is also significant in policy making as it spelt out the specific problems faced by participants and made recommendations on what can be done to effectively utilise and benefit from the skills of immigrant medical practitioners. A multi-agency approach involving key stakeholders from the government departments, regulatory authorities, medical schools and immigrant practitioners themselves is suggested as a possible approach to solving the problems faced by these practitioners.

This qualitative modified participatory study underpinned by social critical theory explored the experiences of immigrant medical practitioners seeking registration in New Zealand. The occupational science notions of occupation, occupational deprivation and occupational apartheid were used to understand the experiences of the participants. The objective of the study was to understand the experiences of the participants and facilitate their self-empowerment through facilitated dialogue, affording them opportunities for collective action. Data was obtained through in-depth interviews and focus group discussions with eighteen immigrant medical practitioners who were doctors and dentists as well as two physiotherapists. The two physiotherapists were sampled out of necessity to explore diversity in findings. Transcripts were analysed using thematic analysis. This method included the processes of coding data into themes and then collapsing themes into major themes which were organised under categories. Four categories were created in the findings describing the experiences of immigrant practitioners and suggesting solutions. Firstly; findings revealed that immigrant medical practitioners had a potential worth being utilised in New Zealand. Secondly; it was found that these participants faced negative and disabling experiences in the process of being registered. Thirdly; the emotional consequences of the negative experiences were described in the study. Fourthly; there were collectively suggested solutions where the participants felt that their problems could be alleviated by support systems modelled in other Western English speaking countries that have hosted high numbers of immigrant medical practitioners from non-English speaking countries. This collective action was consistent with the emancipatory intent of participatory research informed by social critical theory. This study resulted in drawing conclusions about the implications of the participants’ experiences to well-being, occupational satisfaction as well as diverse workforce development initiatives. This study is also significant in policy making as it spelt out the specific problems faced by participants and made recommendations on what can be done to effectively utilise and benefit from the skills of immigrant medical practitioners. A multi-agency approach involving key stakeholders from the government departments, regulatory authorities, medical schools and immigrant practitioners themselves is suggested as a possible approach to solving the problems faced by these practitioners.

This thesis reports on the development of an Australian Government English as a Second Language test for health professionals, the Occupational English Test (OET) , and its validation using Rasch Item Response Theory models. / The test contains sub-tests of the four macroskills, each based on workplace communication tasks. The thesis reports on the creation of test specifications, the trial ling of test materials and the analysis of data from full test sessions. / The main research issues dealt with are as follows: / 1. The nature of the constructs involved in communicative language testing. The term proficiency is analysed, and its relationship to a number of models of communicative competence examined. The difficulty of incorporating into these models factors underlying test performance is identified. / 2. The nature of performance tests. A distinction is introduced between strong and weak senses of the term performance test, and related to the discussion in 1 above. / 3. The content validity of the OET. This is established on the basis of a questionnaire survey, interviews, examination of relevant literature, workplace observation and test data. / 4. The role of classical and Rasch IRT analysis in establishing the qualities of the test. Classical and Rasch IRT analyses are used to establish the basic reliability of the OET sub-tests. The Writing sub-test is shown to be somewhat problematic for raters because of the nature of the writing task involved. Analysis of data from the Reading subtest demonstrates the superiority of the Rasch analysis in the creation of short tests with a specific screening function. / 5. The role of Rasch IRT analysis in investigating the construct and content validity of the test and hence of communicatively-oriented tests in general. Rasch analysis reveals that the sub-tests are satisfactory operationalizations of the constructs 'ESL listening/ speaking/ reading/ writing ability in health professional contexts. For the Speaking and Writing sub-tests, the analysis reveals that responses of raters in categories associated with perceptions of grammatical accuracy have a more important role in the determination of the candidate's total score than was anticipated in the design of the test. This finding has implications for the validity of communicatively oriented tests in general, and illustrates the potential of IRT analysis for the investigation of the construct validity of tests. / 6. The appropriateness of the use of Rasch IRT in the analysis of language tests. The nature of the debate about 'unidimensionality' in Rasch analysis is reviewed. It is argued that the issue has been substantialy misunderstood. Data from the two parts of the Listening sub-test are analysed, and statistical tests are used to confirm the unidimensionality of the data set. It is concluded that Rasch analysis is appropriate for a language test of this type. / 7. The behaviour of raters in the rating of oral and written production in a second language. The findings reported in 5 above suggest that the behaviour of raters is crucial to understanding what is being measured in a communicative test of the productive language skills. / The research demonstrates the value of Rasch IRT analysis in the empirical validation of communicatively oriented language tests, and the potential of large-scale test development projects for theoretical work on language testing.