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‘ PESCI exam is unfair to IMGs ’
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Carmel Sparke DR Michael Mbaogu is finding it almost impossible to recruit doctors to his outback clinic , but it is not for a lack of applicants .
Five GPs have recently left his practice at Mount Isa in western Queensland , leaving just three amid the town ’ s worsening doctor shortage .
Dr Mbaogu regularly receives job applications from overseas-trained doctors .
The problem is that none can pass the pre-employment structured clinical interview ( PESCI ), which is mandatory to practise — even under supervision .
Dr Mbaogu says he is fed up with such a high failure rate among doctors who may have 15-20 years ’ experience in their country of origin .
“ In the past six years or so , it has been almost impossible for overseas-trained graduates to pass that exam ,” Dr Mbaogu said .
“ We do not even know the pass
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rate for that PESCI interview , but it is probably fewer than 10 %, and that is ridiculous .
“ It begs the question — what is going on ? Are these candidates dumber now than they were seven years ago ? What has changed ? “ Why is it that pass rates are so low , especially when
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communities like mine and others across Queensland are very short on doctors ?”
The PESCI assessment typically lasts 60-90 minutes and costs around $ 3000 a go .
It involves a panel of experienced GPs reviewing the IMG ’ s resume , followed by a role-play or
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Dr Michael Mbaogu .
discussion around five potential clinical scenarios .
The RACGP , ACRRM or a private provider called the Institute of Medical Education conducts the assessment , which is mandatory for IMGs who have already completed an Australian Medical Council multiple-choice exam .
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In 2019 / 20 , the overall fail rate for the PESCI was 70 %.
Dr Mbaogu said Mount Isa now had fewer than seven GPs for a population of at least 20,000 , having lost an estimated 10 GPs in the past few years .
Waiting lists at his clinic were three weeks , and he was starting to double-book himself to review patients . He said the long-term fix was to train more doctors — and encourage them into general practice — but the short-term fix was to get more IMGs practising .
“ We need the overseas doctors . They are actually the ones plugging the gap and coming into rural remote communities like mine ,” Dr Mbaogu said .
Dr Mbaogu is a UK-trained doctor himself , having been in Mount Isa for 11 years , following rural practice in WA and Canada .
“ I love it here . But I still want quality of life with it . I do not want to be too stressed , and it is getting to that point now where the work is inundating .”
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Doctors accused of ‘ medicalised rape ’
ALAMY
Paul Smith
THE rendition , detention and interrogation program created by the US Government in the wake of the 9 / 11 attacks still haunts the memory . Yes , the world likes to move on from times past , but the architects and perpetrators who , to critics , carried out state-sponsored torture at Guantanamo Bay in Cuba and the CIA ’ s secret prisons have never been held to account .
And no doubt it is because that phrase ‘ state-sponsored ’ offers special protections from those prepared to violate human rights during their day jobs .
The US Government ’ s use of waterboarding , where a prisoner under interrogation was strapped to a board and a stream of water poured over a rag covering his face to induce ‘ controlled drowning ’, has been widely documented .
But while the interrogation program officially ended in 2009 under the Obama administration , the fallout rumbles on in the margins .
In December , Professor Sondra Crosby and her co-author , Dr Leonard Glantz , described in JAMA the use of rectal feeding by CIA doctors , a practice they called “ a form of medicalised rape ”.
Its use in black site prisons was first reported almost a decade ago after a Senate Select Committee found that at least five detainees held in US custody were subjected to either rectal rehydration or rectal feeding with a liquid nutritional supplement or pureed food .
Although the ‘ treatment ’ disappeared from modern medical practice more than 80 years ago , it was still used on two detainees who were attempting hunger strikes , a detainee
‘ These incidents were clearly very , very distressing to him : shame ; stigma ; very , very painful .’
who partly refused liquid and a detainee who had not been medically assessed beforehand .
Further details of what happened then emerged last year during pre-trial hearings involving Abd al-Rahim al-Nashiri , the man still accused ( not convicted ) of orchestrating the suicide bombing of USS Cole in Yemen , which killed 17 US sailors in 2000 .
Professor Crosby , a physician and professor of medicine at Boston University , spoke at the hearings about her conversations with Mr al-Nashiri back in 2013 when he was being held at Guantanamo Bay .
“ He described sitting in his cell when some men came in , roughed him up , took his clothes , took him somewhere else , bent him over a chair , shackled him , inserted a tube into his anus and administered liquid food ,” she said .
“ There was another incident where he was shackled naked , arms extended above his head , feet shackled and sodomised with a broomstick .
“ These incidents were clearly very , very distressing to him : shame ; stigma ; very , very painful . He experienced them as painful sexual assaults or rape .”
She was asked whether he should have been classed as a hunger striker .
Professor Crosby said he had refused to take a number of meals , but no , he was not on a hunger strike .
“ I should also say the reason he was refusing meals is reportedly that he thought there were medications put into the food . He was paranoid about that .”
It is worth pointing out that whether he was a hunger striker or not is an ethical irrelevance .
As Professor Crosby ’ s JAMA article states somewhat euphemistically , nutrition delivered via rectal administration is “ unfamiliar to modern medicine ” and was never going to work because of basic human biology .
“ For more than 90 years , it has been known that 95 % of nutritional absorption occurs in the small intestine and that it is not possible for nutrients to travel from the rectum retrograde into the small intestine ,” she writes .
“ Nutritional supplements ( such as Ensure ) or pureed food administered into the rectum are simply expelled .”
She continued : “ Nutritive enemata is of historic interest only , having been used in US medicine for patients with bowel disorders dating back to the 1870s and up through the early 20th century .
“[ But ] scientific advances in nutrition
A detainee with guards at Camp Delta , Guantanamo Bay in 2013 .
Abd al-Rahim al-Nashiri .
physiology concluded that nutrients — specifically fats and proteins — are not absorbed to any significant extent through the rectal mucosa , and the practice largely vanished by 1915 .
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