Mia's story

Mia, an internationally qualified nurse and midwife, contacted our office with concerns about how Ahpra and the Board had assessed her application for registration as a midwife. Ahpra and the Board had assessed her midwifery qualification as being relevant, but not equivalent, to an Australian qualification. This meant that Mia was required to successfully complete the outcome-based assessment process to be eligible for registration. She was concerned about:

• a delay in publishing the candidate handbook for the multiple-choice question examination (MCQ exam), which meant this resource was not available when she first took the exam
• not receiving feedback when she first failed the MCQ exam
• the infrastructure for the new assessment framework for the midwifery profession not being in place (after passing the MCQ exam, Mia had sought to undertake the objective structured clinical examination (OSCE), but it was not ready to be delivered)
• having to travel to another state to undertake the OSCE, which caused financial stress and difficulties due to border closures and obligations to isolate.

What we found

We undertook an investigation into the complaint. We found the following:

• It was reasonably open to Ahpra and the Board to decide that Mia’s qualification was not equivalent to an Australian midwifery qualification. However, Ahpra should have provided more detailed reasoning to her about the assessment of her qualification.
• It was reasonably open to Ahpra and the Board to decide that Mia was required to complete the OBA process to demonstrate her suitability for registration. However, Ahpra should have informed her when she was invited to undertake the OBA that it was not yet ready to be delivered. This would have allowed her to plan her next steps for the application or appeal processes.
• There was unreasonable delay in Ahpra’s publication of the MCQ exam handbook, which contained information Mia should have had access to before sitting the exam.
• Mia was initially not provided with feedback about her failed MCQ exam.
• When provided, the feedback about the MCQ exam was different for midwives when compared with nurses (primarily due to the test being run by a different external agency).
• It was reasonably open to Ahpra and the Board to require Mia to travel to South Australia for the OSCE, but it would be better if the OSCE was available at additional locations in the future.
• Given the newness of the OSCE assessment (the first OSCE for the midwifery profession was staged in February 2022) it was not unreasonable that the Board began with one assessment location.
• It was unfortunate and understandably frustrating that the COVID-19 pandemic further exacerbated the difficulty internationally qualified midwives faced in accessing the OSCE.

Complaint outcome

Our office acknowledged that some of the identified concerns were due to the combined effects of implementing a new process and the pandemic, and they may naturally resolve over time. However, the Ombudsman provided formal comments and suggestions for improvement to Ahpra’s CEO regarding several of the findings outlined above. This included:

• suggesting that Ahpra and the Board prioritise improving the quality of the reasons for assessing that an overseas qualification is not equivalent to an Australian one to enhance transparency and to avoid concerns related to discrimination
• acknowledging that while the pandemic has had an unexpected significant impact on the OSCE’s delivery, Mia should have been given greater visibility of the new assessment framework and should have been informed that the OSCE would not be available for another 18 months
• suggesting that it would be better if the OSCE was made available in multiple locations in the future.

Ahpra also agreed to implement a new mechanism for providing feedback to midwives who have failed the MCQ exam.