Office Use Only:


Department of Health
Government of Western Australia


CV
SC
REF 1
REF 2
DATE REC:
CHILD AND ADOLESCENT HEALTH SERVICE & WOMEN’S AND NEWBORNS HEALTH SERVICE
PRINCESS MARGARET HOSPITAL & KING EDWARD MEMORIAL
APPLICATION FOR EMPLOYMENT
- MEDICAL STAFF
SURNAME:
GIVEN NAMES:
ADDRESS:
PCODE
TELEPHONE NO:
(Work)
(Home)
(Mobile)
E-MAIL ADDRESS:
PRIMARY MEDICAL DEGREE:
PLACE:
YEAR:
I HAVE UNRESTRICTED REGISTRATION WITH THE MEDICAL BOARD OF W. A.
WESTERN AUSTRALIAN MEDICAL BOARD REGISTRATION NUMBER:
IS THIS REGISTRATION CURRENT:
YES

NO
Yes

No

__________________________

ARE YOU A CITIZEN AND/OR PERMANENT RESIDENT OF AUSTRALIA?
YES

NO
POSITION APPLIED FOR:
Resident Medical Officer
Registrar
Senior Registrar
Fellow
Chief Registrar





SPECIALTY:
Paediatrics
Neonatology
Obstetrics & Gynaecology
Other sub-specialty (e.g. ICU)




SPECIFY ________________
YES

CAREER OBJECTIVE:
____________________________
HAVE YOU APPLIED TO ANY OTHER WA TEACHING HOSPITAL?
NO

DATE AVAILABLE TO COMMENCE DUTIES: _____________________________
COMMENTS:
________________________________________________________________________________________
________________________________________________________________________________________
I DECLARE THAT THE FOREGOING INFORMATION IS TRUE & CORRECT TO THE BEST OF MY
KNOWLEDGE.
SIGNATURE:
__________________________________________________
DATE: ____________________
Department of Health
Government of Western Australia
CHILD AND ADOLESCENT HEALTH SERVICE & WOMEN’S AND NEWBORNS HEALTH SERVICE
PRINCESS MARGARET HOSPITAL & KING EDWARD MEMORIAL
IS YOUR APPLICATION
COMPLETE?
APPLICANTS NOT CURRENTLY EMPLOYED BY THE
WOMEN’S & CHILDREN’S HEALTH SERVICE ARE
REQUIRED TO SUBMIT THE FOLLOWING ITEMS WITH
THEIR COMPLETED APPLICATION FORMS.
IF ALL OF THE FOLLOWING ITEMS ARE NOT
SUBMITTED YOUR APPLICATION WILL BE TREATED AS
INCOMPLETE AND NOT INCLUDED IN THE SELECTION
PROCESS:
1.
A statement addressing the selection criteria (refer to
section 5 JDF maximum 2 pages).
2.
Current curriculum vitae.
3.
References from two (2) professional referees.
4.
If you have an overseas qualification please supply
evidence that you have passed the I.E.L.T.S.
(See attached medical board policy).
Department of Health
Government of Western Australia
CHILD AND ADOLESCENT HEALTH SERVICE & WOMEN’S AND NEWBORNS HEALTH SERVICE
PRINCESS MARGARET HOSPITAL & KING EDWARD MEMORIAL
RESIDENT MEDICAL OFFICER APPLICATIONS - 2010
Please complete this form and return it with your applications forms:
Senior Administrative Officer
Medical Administration
Women’s and Children’s Health Service
GPO Box D184
PERTH WA 6840
Email: pmhkemh.medadmin@health.wa.gov.au
Fax: (08) 9340 7057
By: Monday, 6th July 2009
(PLEASE PRINT)
NAME: _____________________________________________________________
(Surname)
(Given Names)
1.
Have you applied (or intend applying) for other jobs for 2010?
If so, please list your order of preference including your preference for PMH (Paediatrics) or
KEMH (O&G).
1.
_____________________
4.
_______________________
2.
_____________________
5.
_______________________
3.
_____________________
6.
_______________________
IT IS IMPORTANT THAT THE ABOVE PREFERENCES ARE THE SAME AS THOSE GIVEN TO
OTHER HOSPITAL(S), AS THE TEACHING HOSPITALS EXCHANGE THIS INFORMATION.
2.
Are you intending to practise in WA?



3.
Yes
No
Uncertain
What are your career aspirations?



.

General practice
Paediatrics
Obstetrics & Gynaecology
Undecided
Other (Specify)
____________________________________________________________________________
CONTINUED OVER ……
Department of Health
Government of Western Australia
4.
Are you applying for:
(Please tick)
KEMH (O&G)
PMH (Paediatrics)
12 month appointment
12 month appointment
6 month appointment
6 month appointment
6 month appointment (Joondalup O&G)
6 month appointment (Osborne Park Hospital)
COMBINED
Combined 12 month appointment at PMH & KEMH
Other (Specify)
_______________________________________________________________
5.
Are you enrolled in the RACGP Training Program? (Please tick)
Yes
No
Other (Specify)
_______________________________________________________________
6.
If you are appointed are you available to commence on the starting dates,
i.e. 18th January 2010, 19th July 2010?
Yes
No - If no, please state reason
__________________________________________________________________________________
__________________________________________________________________________________
7.
What is your preference?
18th January 2010
19th July 2010
No preference
Department of Health
Government of Western Australia
CHILD AND ADOLESCENT HEALTH SERVICE & WOMEN’S AND NEWBORNS HEALTH SERVICE
PRINCESS MARGARET HOSPITAL & KING EDWARD MEMORIAL
Only to be completed if applying for Obstetrics and Gynaecology
QUESTIONNAIRE FOR APPLICANTS FOR OBSTETRIC &
GYNAECOLOGY POSITIONS AT
WOMEN’S AND NEWBORN HEALTH SERVICE, KING EDWARD MEMORIAL HOSPITAL
NAME:
________________________________________________________________________
Please complete this questionnaire as best you can. This questionnaire in no way affects the selection
process but is merely designed to optimise the experience available to successful applicants.
CAREER INTENTIONS:
Are you planning a career in
1.
General Practice

2.
Obstetrics & Gynaecology

3.
Other or unsure (specify)
________________________
If general practice is your planned career;
Where do you intend to practice?
Level if intended obstetric care:
1.
City

2.
Rural - regional centre

3.
Rural - remote or small town

4.
Other or unsure (specify)
________________________
1.
Complete, including delivery

2.
Share Care (Antenatal only)

3.
Other or unsure (specify)
________________________
CONTINUED OVER…….
Department of Health
Government of Western Australia
Do you wish to learn procedural skills?
If so, to what level?
Yes

No

1.
Dilatation and Curettage

2.
Forceps and Vacuum delivery

3.
Caesarean Section

QUALIFICATIONS REQUIRED:
Do you wish to sit the Diploma of the Royal Australian & New Zealand College of Obstetrics and
Gynaecology (DRANZCOG)?
Which level?
Basic (six months)

Advanced (twelve months)

The basic is suitable for all doctors who are likely to be seeing female patients in their
practice (ie all branches of medicine including general practice) or those wishing to take
part in shared antenatal care. However it is also suitable for those wishing to undertake
procedural obstetrics in a metropolitan or regional setting with specialist back up
(deliver their own patients but with caesarean section backup by a specialist)
The advanced is more suitable for those wishing to undertake procedural obstetrics (ie
deliver their own patients). See www.ranzcog.edu.au for more information
SPECIAL INTEREST:
Do you have any special interests you wish to pursue at KEMH (eg. Menopause, Family Planning,
Genetic Counselling, Drug Dependence, Gynaecology, etc.)
Please specify:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Department of Health
Government of Western Australia
CHILD AND ADOLESCENT HEALTH SERVICE & WOMEN’S AND NEWBORNS HEALTH SERVICE
PRINCESS MARGARET HOSPITAL & KING EDWARD MEMORIAL
CONFIDENTIAL REFEREE REPORT
A response at your earliest convenience would be greatly appreciated. Once completed, this report should be sent back
to the applicant or alternatively you may fax this report to Medical Administration directly on (08) 9340 7057 or post it to
Medical Administration, GPO Box D184 PERTH WA 6840 AUSTRALIA or email pmhkemh.medadmin@health.wa.gov.au
NAME OF APPLICANT
POSITION APPLIED FOR
NAME OF REFEREE
TITLE
ADDRESS OF REFEREE
POST CODE
TELEPHONE NO:
(Work)
INSTRUCTIONS FOR REFEREES:
This doctor has applied for a position at The Women’s & Children’s Health Service. Please respond to questions 1 to 4
below as well as providing an assessment rating and comments against the questions on page 2 of this form.
1.
Are you aware of any problems regarding this doctor’s physical or mental health?
Yes  No 
2.
Are you aware of any problems regarding this doctor’s use of alcohol or drugs?
Yes  No 
3.
Are you aware of any complaints regarding this doctor, either from patients or other doctors?
Yes  No 
4.
Are you aware of any ethical problems this doctor has which relate to medical practice?
Yes  No 
If you answered “Yes” to any of the previous questions, please provide details below:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
PLEASE PROVIDE WRITTEN COMMENTS ON THE FOLLOWING:
1
The capacity in which you have worked with this doctor?: ___________________________________________
___________________________________________________________________________
___________________________________________________________________________
2
The doctors appropriate clinical experience to undertake the position applied for: _________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
3
When and for how long have you observed this doctor working? ______________________________________
________________________________________________________________________________________________
Department of Health
Government of Western Australia
Please provide an assessment of the doctor against the questions below. You must provide comments where you have
given a rating of Poor (1) or Fair (2). Please provide any other information that you feel the employing organisation should
know about in the public interest.
ASSESSMENT RATING:
Poor – 1
Fair – 2
Average – 3
Good – 4
Very Good – 5
Where the Referee feels he/she is not in a position to provide a rating in any spot, please mark N/A.
1
ASSESSMENT
2
3
4
5
1. Interpersonal & Professional Communications Skills
2. Ability to work effectively as a team member
3. Commitment to improvement of patient outcomes
4. Commitment to continuing medical education
5. Character & Reliability
6. Professional Judgement & Conduct
7. Attitude Towards Developing New Skills
8. Dedication & Interest towards pursuing a career in
Medicine
COMMENTS:
Please provide written comments if your assessment rating was Poor (1) or Fair (2). Use additional pages as required.
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Please feel free to provide any additional comments on the applicant’s suitability for the position:
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
This report is provided to the employing Hospital on a confidential basis for the purpose of the process of assessing suitability for employment.
The referee understands that this report may be provided to consultant assisting in this process. The Women’s & Children’s Health Service is
subject to the provisions of the Freedom of Information Act 1992 and subject to the Legislative obligations flowing from this Act, the Hospital will
endeavour to keep this report confidential.
________________________________________________________________________
Signature of Referee
Date
Department of Health
Government of Western Australia
CHILD AND ADOLESCENT HEALTH SERVICE & WOMEN’S AND NEWBORNS HEALTH SERVICE
PRINCESS MARGARET HOSPITAL & KING EDWARD MEMORIAL
CONFIDENTIAL REFEREE REPORT
A response at your earliest convenience would be greatly appreciated. Once completed, this report should be sent back
to the applicant or alternatively you may fax this report to Medical Administration directly on (08) 9340 7057 or post it to
Medical Administration, GPO Box D184 PERTH WA 6840 AUSTRALIA or email pmhkemh.medadmin@health.wa.gov.au
NAME OF APPLICANT
POSITION APPLIED FOR
NAME OF REFEREE
TITLE
ADDRESS OF REFEREE
POST CODE
TELEPHONE NO:
(Work)
INSTRUCTIONS FOR REFEREES:
This doctor has applied for a position at The Women’s & Children’s Health Service. Please respond to questions 1 to 4
below as well as providing an assessment rating and comments against the questions on page 2 of this form.
5.
Are you aware of any problems regarding this doctor’s physical or mental health?
Yes  No 
6.
Are you aware of any problems regarding this doctor’s use of alcohol or drugs?
Yes  No 
7.
Are you aware of any complaints regarding this doctor, either from patients or other doctors?
Yes  No 
8.
Are you aware of any ethical problems this doctor has which relate to medical practice?
Yes  No 
If you answered “Yes” to any of the previous questions, please provide details below:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
PLEASE PROVIDE WRITTEN COMMENTS ON THE FOLLOWING:
1
The capacity in which you have worked with this doctor?: ___________________________________________
___________________________________________________________________________
___________________________________________________________________________
2
The doctors appropriate clinical experience to undertake the position applied for: ________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
3
When and for how long have you observed this doctor working? ______________________________________
________________________________________________________________________________________________
Department of Health
Government of Western Australia
Please provide an assessment of the doctor against the questions below. You must provide comments where you have
given a rating of Poor (1) or Fair (2). Please provide any other information that you feel the employing organisation should
know about in the public interest.
ASSESSMENT RATING:
Poor – 1
Fair – 2
Average – 3
Good – 4
Very Good – 5
Where the Referee feels he/she is not in a position to provide a rating in any spot, please mark N/A.
1
ASSESSMENT
2
3
4
5
1. Interpersonal & Professional Communications Skills
2. Ability to work effectively as a team member
3. Commitment to improvement of patient outcomes
4. Commitment to continuing medical education
5. Character & Reliability
6. Professional Judgement & Conduct
7. Attitude Towards Developing New Skills
8. Dedication & Interest towards pursuing a career in
Medicine
COMMENTS:
Please provide written comments if your assessment rating was Poor (1) or Fair (2). Use additional pages as required.
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Please feel free to provide any additional comments on the applicant’s suitability for the position:
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
This report is provided to the employing Hospital on a confidential basis for the purpose of the process of assessing suitability for employment.
The referee understands that this report may be provided to consultant assisting in this process. The Women’s & Children’s Health Service is
subject to the provisions of the Freedom of Information Act 1992 and subject to the Legislative obligations flowing from this Act, the Hospital will
endeavour to keep this report confidential.
________________________________________________________________________
Signature of Referee
Date
Department of Health
Government of Western Australia
MEDICAL BOARD OF WESTERN AUSTRALIA
ENGLISH LANGUAGE TESTING FOR OVERSEAS TRAINED DOCTORS (CONDITIONAL
REGISTRATION)
EFFECTIVE 1 FEBRUARY 2005
1.0
Introduction
The Medical Board of Western Australia is charged with the responsibility of ensuring that
medicine is practised in Western Australia in accordance with the requirements of the Medical Act.
This includes ensuring that only individuals who are competent, have a sound knowledge of the
English language and are of good character are registered as medical practitioners in Western
Australia.
While the Medical Board has no direct role with respect to the medical workforce issues, it is
mindful of the fact that over the past four years the number of overseas trained doctors who are
not eligible for General / Unconditional registration is increasing.
Many Overseas Trained Doctors come from a non-English speaking background and English
language proficiencies have been found to be variable.
Section 11AA of the Medical Act requires that the Board must be satisfied that the person seeking
registration:
‘has sound knowledge of the English language and possesses sufficient skill in the
expression of that language, both written and oral, for the practise of medicine’.
The Medical Board determined that, as a consequence of stakeholder feedback, mandatory
English Language Testing be implemented for Overseas Trained Doctors seeking registration.
2.0
English Language Testing Model
The Medical Board is of the view that an acceptable level of English language proficiency is
essential to enable practitioners to communicate with patients, other doctors and health
professionals and for maintenance of professional standards.
The Board considers the International English Language Testing System (IELTS) is an appropriate
language testing model for those doctors seeking Conditional Registration on or after 1 July 2004.
Refer to www.ielts.org which provides useful information.
The IELTS test was developed by the University of Cambridge Local Examinations Syndicate, The
British Council and IDP Education Australia. The test is administered at least once a month by
IELTS Australia and The British Council at over 230 centres worldwide.
Applicants should contact IELTS Australia on all matters relating to the administration of the IELTS
English Test (Academic module), examination dates and its associated procedures. The IELTS
English Test is held throughout Australia as well as overseas. The contact for IELTS Australia is:
Tel:
Email:
Website:
(02) 6285 8222
ielts@idp.edu.au
www.ielts.org
Department of Health
Government of Western Australia
3.0
Medical Board Requirements
Applicants need to submit evidence of an adequate command of English as demonstrated by
having completed the IELTS to the following standard:
-
The Board will require the minimum score 7 to be obtained in all components in the
IELTS (Academic Module).
-
Alternative proficiency tests that will be accepted are:
a) Completed and obtained an overall pass in the Occupational English Test (OET)
administered by Language Australia with grades A or B only in each of the four
components;
b) A pass in the English language component of the United States Medical Licensing
Examinations (USMLE) (NOT the TOEFL component of the current USMLE
examination);
c) A pass in the Professional Linguistic Assessment Board (PLAB) in the United
Kingdom; or
d) A pass in the New Zealand Registration Examination (NZREX) in New Zealand.
An IELTS (or approved equivalent) Test Report Form more than two years old will be accepted as
evidence of present level of ability if accompanied by proof that a candidate has actively
maintained employment as a medical practitioner in a country where English is the native or first
language.
3.1
Exemption
The following exemptions are to apply:
 an exemption is available when an applicant provides certified copies of documentary
evidence of:
(i)
birth certificate and formal primary education or
(ii) completion of secondary education (not University training)
in a country where English is the native or first language (not merely the
official language).
Exemptions may apply in special circumstances. That is:
 To demonstrate techniques;
 To undertake research which involves limited or no patient contact;
 To undertake postgraduate study or training who will be working in an appropriately
supported environment which will ensure patient safety is not compromised.
The English Language Test requirement will be applicable to all incoming medical practitioners,
including those applying for registration pursuant to Mutual Recognition.
It is important to note that:

the applicant is responsible for the cost of the test.
Department of Health
Government of Western Australia
CHILD AND ADOLESCENT HEALTH SERVICE & WOMEN’S AND NEWBORNS HEALTH SERVICE
PRINCESS MARGARET HOSPITAL & KING EDWARD MEMORIAL
EMERGENCY DEPARTMENT
Princess Margaret Hospital is the tertiary referral centre for Paediatrics for the state of Western
Australia.
The Emergency Department at Princess Margaret Hospital sees 46,000 paediatric patients annually with
an admission rate of 21%.
The Department was refurbished in 2004 and now provides 22 assessment cubicles and two wellequipped resuscitation bays, equipped with XR gantry. A Procedure Room is equipped with Image
Intensifier and is adjacent to the satellite XR facility. There are dedicated rooms for psychiatric
assessment and plastering. An ophthalmologic slit-lamp is located in the Eye Assessment/Dental
Treatment room.
The Department has a Short Stay/Observation ward of 6 beds and one Isolation (negative-pressure)
Room which allows the Emergency Department to treat illnesses such as asthma, croup, minor trauma
and gastroenteritis (including rapid nasogastric rehydration).
The computerised Emergency Department Information System (EDIS) facilitates tracking of patients and
patient handovers.
Department clinical guidelines and electronic textbooks (including
pharmaceutical/Paediatric texts/ therapeutic books) and electronic information bases such as Poisindex
and Medline are available on the Department terminals. The well-stocked Department library collection
includes texts relevant to Basic Sciences as well as Paediatrics, Paediatric Medicine Specialties and
Paediatric Emergency Medicine and Toxicology. The Medical Library houses an extensive collection of
lending and reference material. A consumer health information resource for parents, patients and the
general public is soon to be opened and will augment the patient handout service currently provided by
the Emergency Department.
The hospital has units dedicated to Paediatric Intensive Care and Neonatal Intensive Care and the full
range of Paediatric Medical, Surgical and Orthopaedic Specialties are available to consult to the
Emergency Department. The usual pathology services and radiology including CT and MRI support the
Emergency Department.
STAFFING
The Department is headed by Gary Geelhoed and is part of the division of paediatric clinical care. The
staff are supervised by Paediatric (3.8 FTE) and Emergency Medicine (2.4 FTE) Consultants who
provide on-floor cover 0800-2130 Mon-Fri, 0800-1300 Sat and 1300-2130 Sun. and readily available oncall at all other times. The junior medical staff work in teams of two registrars (one paediatric trained,
one ED trained) and two or three resident medical officers. Additional staffing is provided at weekends
and evenings. The nursing staff consists of many highly skilled and experienced staff that are supported
by a full-time nurse educator.
PTO
Department of Health
Government of Western Australia
THE TEACHING PROGRAM
The ACEM Director of Emergency Medicine Training is Meredith Borland. The Department is fully
accredited for training in Paediatric Emergency Medicine with the Royal Australasian College of
Physicians and for 6 months ED training, as well as 6 months Paediatrics with the Australasian College
for Emergency Medicine (ACEM). With around 25% of presentations being Australasian Triage Scale
categories 1-3, there is ample opportunity to fulfil the ACEM Minimum Paediatric Requirement within the
usual 6 month Registrar post. The ACEM designated procedures are readily achievable. Rotations to
the Paediatric Intensive Care Unit may be arranged.
The Department runs weekly protected education sessions for resident staff for the whole hospital
(covering a broad range of paediatric topics) as well as specific sessions for Emergency Medicine
registrars (which focus on Paediatric Emergency Medicine topics and include practical sessions in
resuscitation, trauma and disaster management). There are a number of interactive morning education
sessions which complement the formal teaching program. Registrars participate in critical evaluation
and ongoing development of the Department’s Clinical Guidelines and are encouraged to present at the
weekly Department Journal Club and the Joint ICU/Emerg Dept monthly Trauma meeting. The
Department also participates in interhospital Toxicology Meetings, hospital Grand Rounds and Clinical
Paediatric Conferences.
Consultant staff participate in a broad range of paediatric teaching programs including the Western
Region Rural and Remote Trauma Course, the University of Western Australia’s Diploma of Child
Health, and the Advanced Paediatric Life Support (APLS) and Paediatric Life Support (PLS) and Major
Incident Medical Management and Support (MIMMS) Courses. Registrars are encouraged to attend
these courses and may assist in teaching if desired.
RESEARCH
The Department is recognised internationally for its clinical research in Respiratory Medicine, in
particular asthma and croup. Research is actively promoted within the Department. A fellowship in
Paediatric Emergency Medicine allows for a combination of part-time clinical work and research. The
three senior registrars are encouraged to have an active research interest. The Department supports a
Trauma Registry Nurse and an Injury Surveillance Officer.
The Department is actively involved in a number of multi-centre national and international research
projects.
Clinical research is facilitated by the computerised patient database, Major Trauma Registry and Injury
Surveillance databases.