As I step down from my role as vice president, I want to share a personal story. Not as an office holder, but as a fellow surgeon.

I arrived in Australia 30 years ago. I was already a trained and practising otolaryngology head and neck surgeon in South Africa. Yet here, I found myself starting again as a Specialist International Medical Graduate (SIMG).

I had to redo my surgical training and resit my exams. It was tough. Arduous. At times, I questioned why it needed to be so—why I had to work so hard to prove myself when I had already been deemed safe and competent in my home country.

That experience drew me closer to my involvement with the College.

In 1996, I gained my Fellowship. Seven years later, I joined the Court of Examiners. I went on to become the Senior Examiner in Otolaryngology, and later Chair of the Court.

A shift in perspective

It was as Chair of the Court that my perspective shifted most. I saw, up close, the role of the Fellowship Examination in maintaining standards. I saw how it ensures that all surgeons practising in Australia and Aotearoa New Zealand—regardless of where they trained—are assessed against the same benchmark.

I came to understand that the College’s assessment of SIMGs is rigorous for a reason. It is critical to maintaining standards and protecting patients.

When a patient sees FRACS after a surgeon’s name, they know they are in good hands. That trust underpins our profession. It is both a privilege and an obligation—a promise we must uphold.
The College fulfils that promise every time through its SIMG assessment process.

Evolving the approach

And yet, perspectives continue to evolve.

My year as vice president has given me a broader view. I now believe that while the Fellowship Examination serves us well, it may not be the most appropriate way to assess our SIMGs—particularly those who have been practising safely for many years.

High stakes exit exams are designed for Trainees completing their training. They are less suited to experienced specialists.

We need an approach that maintains standards, supports access to care in rural and regional communities, and responds to a changing regulatory environment.

I believe we can achieve this. The College has already begun this work through the External Validation of Professional Performance program (EVOPP).

A pathway forward

EVOPP is a reliable workplace-based assessment. It evaluates surgeons in their real clinical environment—across theatre, outpatient settings and ward rounds. It includes structured observations, colleague feedback and case-based discussions. All evidence is brought together to assess readiness for independent practice.

The process is robust. It assesses across multiple core competencies. It is valued by both assessors and candidates. And importantly, it reflects how surgeons actually practise.

There is more to do. We need clarity on which candidates are best suited to this pathway, and what follows if an assessment is unsuccessful. But the direction is promising.

This work is also timely. Recent government decisions in Australia to expedite pathways in areas such as General Surgery and Otolaryngology make it even more important that we have rigorous, contemporary assessment models in place for SIMGs.

My hope is that the College continues to invest in this work. That we build a cross-specialty assessment capability. And that we remain focused on both standards and access.

As I step away from this role, I do so with confidence in the future of the College.

With Philip Morreau and Christine Lai taking on the roles of president and vice president respectively, the College is in capable hands. I wish them every success.

Thank you for the opportunity to serve as your vice president. It has been a privilege.

Warm regards,

Professor Ray Sacks
Vice President