Training for NZ Doctors

These training notes are for New Zealand registered doctors and General Practitioners with a special interest in Musculoskeletal Pain Medicine.
If you are a member of the public, you can find out what we treat on the Patients page and where you can find a doctor via our Directory of Musculoskeletal Doctors

If you are an international medical graduate (IMG) wishing to work as a specialist in Musculoskeletal Medicine in New Zealand, please read further down the page to the IMG section.

Musculoskeletal problems are increasingly common and complex as our population ages. There are a number of Musculoskeletal Medicine Specialists throughout New Zealand and many General Practitioners with a special interest in Musculoskeletal Medicine.

Director of Training Dr Holtzhausen and Registrars at the 2020 NZAMM Conference in Wellington

Training Pathways

General Practitioners with a Special Interest in Musculoskeletal Medicine

NZAMM is actively involved in the Education of its members, General Practitioners and Allied Health Professionals in all aspects of Musculoskeletal Medicine. It is also responsible for training it’s members in treatments which are safe and, where possible, evidence-based. There is training available in hands-on assessment and treatment methods for musculoskeletal pain and dysfunction. NZAMM can provide you with access to CME and peer support. Please complete a membership application form to ensure you are informed about training opportunities. For further information, talk to one of our members or email info@nzamm.org.nz.

NZAMM is a registered CME provider for the RNZCGP.

NZAMM is expanding its educational Role for GP members. This will include:

  • Clinical Mentorship: Fellows of the Association have offered individual clinical support to GP members. This is an informal process and is mostly conducted online or, if necessary, by phone.
  • Musculoskeletal Peer Review: Regular such meetings are planned with one or two specialists being present. The Association uses Zoom via the Internet.
  • Practical Workshops: These have always been successful in the past and more are planned.

At a national level, there are a number of regular ongoing activities to which GPs are welcome including:

  • Annual Musculoskeletal Conference: Usually associated with workshops and a “Retreat”. Held in NZ and Australia, alternately.
  • NZAMM/ AFMM Retreat Weekends: These occur three times a year. Much of the time is spent on clinical discussion, peer review and case presentation. Members only.
  • Yearly Practical Workshop: Intended to enhance manual and rehabilitation skills.

To access these, go to the Events and Conferences page and contact the relevant organiser.

To view current member listings go to the Member Directory here.

If you have a special interest in Musculoskeletal Medicine, and are a member of NZAMM a listing can be made available for your practice. Contact us at info@nzamm.org.nz to enquire about this.

Musculoskeletal Medicine Training Pathways

Two more pathways exist for someone interested in further study of Musculoskeletal Medicine:

  1. General Practitioner or
  2. Specialist with CAMM and Fellowship

Backgrounds of Musculoskeletal doctors vary and options of what you can do with a Musculoskeletal Medicine qualification vary enormously.  A common theme is that Musculoskeletal specialists have huge enthusiasm for making a difference for their patients. The following diagram provides an idea of the variety of pathways that you can explore in this specialty and the levels of engagement that you can have:

 

NZAMM Summary of Training Programme

 

Maintaining CPD

Ongoing re-certification in Musculoskeletal Medicine is dependent on the successful annual completion of the NZAMM/ AFMM Continuing Professional Development programme using the AFMM ePortfolio hosted by BPAC.

Trainees do not need to maintain CPD in this way until they have  completed training as the Medical Council understands they are under supervision. They will need to continue CPD in any other vocational scope.

General Practitioner with a special interest in Musculoskeletal Medicine will re-certify through RNZCGP using any training and peer group work NZAMM provides as part of their MOPS submission and professional development plan.

A Continuing Professional Development (CPD) Programme provides Specialists in Musculoskeletal Medicine with a way of formally documenting their participation in a range of quality assurance, continuing medical education and training & research activities. The objectives of the programme are similar to those listed by the Royal Australasian College of Physicians. They are as follows:

  • to ensure that specialists in musculoskeletal medicine are involved in a range of continuing educational activities, which are directed at enhancing clinical standards throughout their professional careers, so that clinical practice and patient care of the highest quality will continue to be provided
  • to demonstrate to patients, peers, government bodies and the community at large, that specialists in musculoskeletal medicine are committed to programs of continuing medical education and quality assurance
  • to develop an approach which supports the improvement of the performance of all Participants and not one primarily directed at identifying under-performing physicians
  • to provide a formalised procedure which can demonstrate participation in Continuing Medical Education (CME) and Training & Research (TR) for such purposes as registration or employment
  • to additionally provide a formalised and documented clinical practice audit (the Quality Assurance (QA) section of MOPS).

Fellows who would like more detailed information about the CPD/MOPS programme click here

Vocational Training in Musculoskeletal Medicine

The purpose of training in Musculoskeletal Medicine is to produce specialist doctors with competence and skills in managing musculoskeletal and pain problems.

Trainees are required to complete a specified programme of training and examination (see Summary of Training Programme) to be eligible for admission to be a Musculoskeletal Medicine Specialist by NZAMM (CAMM) and to Fellowship of AFMM under Articles 49, 50, 51, and 52 of the Articles of Association of AFMM.

Prospective trainees should first become members of NZAMM in accordance with the Articles of Association and enrol in the Postgraduate Diploma of Musculoskeletal Medicine undertaken via Otago University. Click here to see the outline of the requirements for the Postgraduate Diploma in Musculoskeletal Medicine.

To be eligible for entry to the NZAMM Specialist training programme, potential candidates must hold:

  • MBBS and/or MBChB qualifications gained at a University approved by the Medical Council of New Zealand
  • Full registration with the Medical Council of New Zealand
  • A Current Annual Practicing Certificate issued by the Medical Council of New Zealand
  • Have completed post-graduate years 1 and 2 (PGY1 & 2)
  • Have Membership of the Medical Protection Society or other professional indemnity insurance
  • References from two referees
  • Passes in: Papers MSME 701 (Clinical Diagnosis) and MSME 711 (Pain Assessment) offered in the Postgraduate Diploma of Musculoskeletal Medicine at the University of Otago

Application and registration

New Zealand medical graduates wishing to train in the speciality of Musculoskeletal Medicine need to apply and continue as members with the NZAMM and with the AFMM and satisfy all the eligibility criteria in the previous paragraph. Documents that need to be submitted, along with the training application form, include:

  • Certified copies of relevant Degrees or Diplomas
  • A Comprehensive Curriculum Vitae
  • References from two Australian or New Zealand referees with names and contact details
  • Proof of identity, Passport or New Zealand Driver’s license
  • Copy of the Annual Practicing Certificate
  • Copy of current Medical Indemnity certificate
  • Proof of having completed and passed the MSME 701 and MSME 711 papers (Postgraduate Diploma of Musculoskeletal Medicine Otago University)

The following diagram indicates the training application process:

Click to access and download our NZAMM Registration form and the NZAMM Training Application form.

Steps to Becoming a Musculoskeletal Specialist

The following steps summarise the path to Specialising (Vocational Registration) in Musculoskeletal Medicine:

Become Member of the Association (NZAMM)

  • Complete NZAMM membership application form + fee
  • Two current financially paid up Members to nominate you
  • Complete MSMX701 & MSMX711 DipMSM (Postgraduate papers towards Diploma of Musculoskeletal Medicine Otago University)

Apply to do Training Course

  • Application Form + fee
  • Receive Summary of Training
  • Provide necessary supporting information as per application
  • Return to Administrator

Acknowledgement

  • Will be sent to you by Administrator on receipt of Application within 5 working days
  • Will give time frames for processing Application by Board of Censors (Summary of Application Time Frames for prospective trainees)
  • Will receive a notice of Acceptance for an Interview (or Decline if not suitable)
  • If accepted will be given date/place of interview by Panel (in person or by telecommunication) & forwarding of the Full Training Manual

Interview

  • Will be a structured interview following a Faculty developed protocol
  • Panel of Three from Board of Censors/Training Committee, or if by telecommunication, preferably with one panel member personally present

Acceptance

  • Formal letter of acceptance/decline into training program
  • Meeting with Director of Training and Supervisor to review Portfolio and how to action the various elements of the Training Program
  • Rotation through Training posts
  • Elective placements
  • Study & retreat commitments
  • Syllabus and core references
  • Individualised timeline
  • MoU (or contract) signed by both parties
  • Presented with personal Portfolio of Learning
  • Determines which elements of training already “met”
  • Prior experience may determine which elements of the Training Program will need to be undertaken
  • Receive an Approval to Commence Training e. Names of your Supervisor & Mentor

Fees:

  • Annual Training fee – includes CPD (Comprises both Annual Membership fees of NZAMM and AFMM and a Training Levy)
  • To be paid within one month of invoice

In Training:

  • Maintain and submit 3 monthly Case Log, Log of Clinical Proficiency / Portfolio of Learning to Supervisor
  • Complete and submit to Supervisor Trainee Placement Reports
  • Maintain Annual CPD reporting and submit to Administrator each year, along with APCn/evidence medical indemnity
  • Attendance at Retreats and Training Days
  • Review of learning requirements, identification of deficits and plan to address these
  • Annual review with Supervisor/Director of Training with annual Approval to Continue Training being given
  • Preparation for Fellowship Examinations

Disputes: Be aware of process for resolving disputes

  • Mentor
  • Board of censors

Final Examination

  • Apply to sit the final examination
  • The DoT will forward a “Candidate ready to be Examined” notice to Board of Censors via the Administrator
  • Receive an Invitation to be Examined from Board of Censors, with time and place
  • If deferment then Board of Censors and Supervisor will formulate a program to satisfactorily complete training to the standard required, or preparedness for examinations
  • Examination date to be set within 2 months of receipt of candidates readiness for examination
  • Fellowship and CAMM examination – 2 parts + fee
  • By 2 hour, 100 question MCQ (as described in training manual)
  • By oral viva e. The oral viva will only be offered upon successful completion of the written examination. The oral viva is to be offered within 3 months of successful completion of the written examination

Awarding of the CAMM and Fellowship

  • Letter to candidate of either successful in obtaining Fellowship in Musculoskeletal Medicine or unsuccessful
  • Letter to NZAMM advising that the Candidate was successful and can be awarded a CAMM
  • Letter from Censor in Chief to MCNZ advising them that the candidate has been awarded CAMM in Musculoskeletal Medicine (to be done within 1 month of passing)
  • Formal presentation of Fellowship at next Faculty Retreat

International Medical Graduates (IMG)

The qualifications of Certificate of Attainment in Musculoskeletal Medicine and Fellow ship of NZAMM is unique to New Zealand. The Medical Council of New Zealand, but not the Australian Medical Council, recognises the Fellowship for purposes of vocational (specialist) registration in Musculoskeletal Medicine.

The following refers to applying for vocational registration  in Musculoskeletal Medicine from outside New Zealand and without NZ qualifications.

International Medical Graduates (IMGs) seeking to train or work in Musculoskeletal Medicine in New Zealand are obliged to follow the process set by the Medical Council of New Zealand (MCNZ).  https://www.mcnz.org.nz/registration/getting-registered/moving-to-practise-in-new-zealand/

If an IMG with an overseas post graduate medical qualification in a field rich in Musculoskeletal Medicine ( such as non-operative Orthopaedics,  Physiatry, Regenerative  Medicine or Rehabilitation) applies for vocational registration with MCNZ, the Council may ask NZAMM for advice about the IMG’s qualifications, training and experience (QTE) and whether this is at the level of a New Zealand trained specialist in musculoskeletal medicine. MCNZ will consider NZAMM advice and decide if the IMG is suitable for the provisional vocational registration pathway. An IMG who wishes to appeal the outcome of an application should do so through MCNZ appeal processes.

On receipt of the request for advice by MCNZ, an NZAMM  assessment panel considers the IMG’s application, by means of a paper-based assessment.  The panel compares the applicant’s supporting documents with the prescribed NZAMM Fellowship  programme outcomes, using an IMG assessment template. The panel will consider references and referee reports. Each component of the template is graded for relative equivalence to a New Zealand trained specialist in musculoskeletal medicine, followed by an overall assessment of equivalence. NZAMM then considers and proposes pathway requirements for the applicant  to the MCNZ.  The panel may also require a formal interview to provide further information on clinical expertise, and will assess other domains, including communication and professionalism.

Once a decision has been made by MCNZ to provide provisional registration in the vocational scope  of Musculoskeletal Medicine . a period of supervised practice will take place according to a decision by NZAMM and working with MCNZ.

NZAMM Training Manual

The NZAMM training manual is a comprehensive overview of the NZAMM training programme, the eligibility criteria for entrance into the training programme, the governance structure of the programme, what is expected of a trainee, the way in which the programme is structured, the assessments made during clinical placements and the exam process.

Open Training Manual

NZAMM Vocational Training Curriculum

NZAMM / AFMM  have produced a comprehensive and fully referenced Curriculum pertaining to Musculoskeletal Medicine speciality training. The objectives of the Curriculum are to outline the body of knowledge necessary for Musculoskeletal Physicians to achieve expertise in the management of musculoskeletal pain disorders.

The curriculum is designed to be a practical resource which clearly outlines the learning requirements for those undertaking the Musculoskeletal Medicine vocational training pathway. It represents a comprehensive statement on the unique body of knowledge, competencies, skills and attributes required for Musculoskeletal Medicine practice.  Through the developing this resource, we now a clear view of what, where and how  Musculoskeletal Medicine trainees and fellows need to learn in order to undertake safe and independent practice across a range of communities in New Zealand.  It also provides a framework from which to plan specific educational, assessment and professional development processes. The development of the curriculum promotes transparency, consistency and academic rigor, in these educational processes. It also represents a fundamental resource for Musculoskeletal Medicine trainees, supervisors and teachers, providing clear information on what is to be expected from vocational education and life-long professional development.

Trainees are examined in all aspects of the Curriculum, to the level required by the Board of Censors.

The specific objectives of the Curriculum are each complemented with references to the available literature. These references constitute the key scientific publications that make up the evidence-base for this subject. However, in some instances references are provided to prominent or influential publications to expose trainees to the broad diversity of views that pertain to some areas of musculoskeletal pain medicine. NZAMM considers that trainees and Fellows should be conversant with this literature and the diversity of views.

Open Curriculum