Why Reference Checks Matter for Locum Doctors in Australia (Part 2)

Introduction

In part 1 of our reference checklist we explored the how to get a reference check. Though at Medlo, we were getting more questions about “why”, so let’s get into it.

Locums & agency staff play a vital role in sustaining healthcare delivery across the Australian public health system.

Given the dynamic nature of their employment—frequently rotating through various hospitals and clinical settings—it is imperative that robust credentialing processes are in place. These measures ensure patient safety, maintain clinical standards, and uphold the professional integrity of the healthcare workforce.

Medlo mandates a formal vetting process which includes the assessment of clinical competencies and professional behaviour through standardised forms, namely the Referee Check – Clinical Skills Assessment and Referee Check – Professional Behaviour.

This guide will explore how these assessments function, why they are important, and how healthcare professionals can navigate them effectively.

Understanding Locum Medical Officers

Who Are Locum Doctors?

Locum doctors are temporary medical practitioners engaged to fill short-term vacancies across hospitals and health facilities. They offer essential flexibility to the health system by covering staff shortages, peak demand periods, or leave absences. Locums may operate across a wide range of specialities and locations, often adapting quickly to unfamiliar clinical environments.

Why They Are Vital to the Healthcare System

In regional and rural areas of Australia, locum doctors are particularly indispensable.

They provide critical care continuity in areas that face persistent recruitment challenges. Their contributions enable public health organisations to maintain service delivery without overburdening permanent staff or compromising patient care.

You can find out more here on the top benefits, and why we want to create a transparent medical system.

Challenges Associated with Locum Staffing

Despite their value, the integration of locum doctors comes with challenges. These include variations in clinical practice, unfamiliarity with local systems, and the need for quick orientation. To mitigate these risks, Medlo relies heavily on rigorous reference checks and credential verification to ensure locums are competent, trustworthy, and adaptable.

The Role of Referee Checks in Clinical Assessment

What Is the Referee Check – Clinical Skills Assessment?

A Clinical Skills Assessment is a way to formally assess and verify a locum doctor’s practical competencies. This assessment form must be completed by a referee who has directly observed the doctor’s performance or has access to documented evidence of their clinical capabilities. It covers a broad range of medical skills, from basic procedures to emergency and intensive care interventions.

Purpose and Legal Framework

The assessment is grounded in a need to meet clinical governance standards and legal obligations. For instance, when assessing suitability for psychiatric roles, referees must verify the doctor’s working knowledge of the Mental Health Act, which governs involuntary treatment and patient rights. These legal contexts necessitate clear, accountable verification of a candidate’s readiness to practise safely.

What Is Asked In a Clinical Skills Assessement

Medlo uses a structured checklist, allowing referees to categorise a doctor’s skills based on direct observation, reports from others, or uncertainty. The checklist includes competencies across multiple disciplines such as emergency medicine, ICU care, general medicine, and paediatrics. Its comprehensive design helps ensure the doctor has the range of skills required to function effectively in varied clinical environments.

Why References Are Important

Understanding Their Purpose

References are a cornerstone of the credentialing process. They provide third-party validation of a medical officer’s clinical competence, professionalism, and interpersonal conduct. These insights are typically based on real-time observations and cumulative experience working alongside the practitioner in high-pressure clinical settings.

Minimum Requirements

Most NSW Public Health Organisations require a minimum of three references to ensure that evaluations are thorough and balanced. This triangulated approach reduces the risk of bias and enhances the reliability of the information provided. A single reference may overlook key strengths or weaknesses, but three distinct perspectives offer a more rounded picture.

How to Ask for a Reference

We explore this more in part 1 though in brief:

Choosing the Right Referee

When selecting referees, it’s important to approach individuals who have had substantial oversight of your clinical work. Ideal referees include senior registrars, heads of unit, or consultants. These professionals are well-placed to comment on your technical skills, clinical judgement, team interactions, and ability to handle pressure.

How to Approach Them

Requesting a reference should be done courteously and professionally. Explain why you need the reference and what it will be used for. It helps to remind your referee of the work you did together and offer a copy of your current CV or a summary of recent roles. Make it easy for them to provide a thoughtful, specific, and accurate account of your performance.

The Verification Process

Workflow for Reference Validation

Once references are submitted, the verification process begins. This typically involves checking the referee’s identity, confirming their relationship with the applicant, and validating the information provided. Contact details are cross-checked against hospital directories or professional registration databases to ensure authenticity.

The referee forms are then reviewed by the Medical Workforce Unit, who assess whether the submitted information aligns with the required standards and scope of practice for the locum role.

Medlo Digital Verification

Medlo captures referee details, including timestamps, IP addresses, and geolocation data. This creates a traceable digital footprint, ensuring the referee is genuinely who they claim to be and that the document has not been tampered with.

You can find out here what other how you can certify other documents too with Medlo.

Skill Categories Assessed in the Referee Check

General Medical Competency

Referees evaluate the doctor’s ability to perform routine clinical procedures such as peripheral venous cannulation, ECG interpretation, and urethral catheterisation. They must also assess the doctor’s judgement in knowing when to seek help and how to function under supervision.

Emergency Medicine and Trauma Care

Skills in managing trauma, interpreting diagnostics, and initiating treatment for common emergency presentations are scrutinised. This includes handling dislocations, fractures, and foreign body removal using tools like slit lamps and ENT instruments.

In-Charge Capabilities and Supervision

Being “in-charge” involves overseeing junior staff, coordinating patient care, and escalating issues when necessary. Referees assess the candidate’s leadership, delegation, and communication skills, especially in high-stakes scenarios.

ICU and Ventilation Proficiency

Skills such as mechanical ventilation, use of CPAP/BiPAP, and management of vasoactive drugs are critical for ICU roles. Referees confirm whether the doctor can function at a registrar level in intensive care environments.

Surgical Experience and Trauma Response

This involves recent hands-on experience in surgical subspecialties and trauma settings. The referee must indicate whether the doctor is capable of making independent decisions during acute surgical scenarios.

Psychiatry and Internal Medicine Competency

For psychiatry, the focus is on understanding the State specific Mental Health Acts and functioning within a multidisciplinary team. Internal medicine assessments include synthesising patient history, examination findings, and diagnostic results to formulate a management plan.

Specialised Skill Assessments

Paediatric Care Capabilities

This assesses the doctor’s comfort with paediatric patients, including basic examination, venous access, and communicating with children and their caregivers.

Neonatal Resuscitation and Cannulation

Proficiency in neonatal ventilation, use of neopuff devices, and placement of umbilical lines are evaluated. These skills are essential in neonatal ICUs and emergency settings.

Advanced Life Support in Children

The referee checks if the doctor has experience in advanced paediatric life support, including manual ventilation, intubation, and resuscitation algorithms.

Airway and Breathing Management Skills

Competence in adult and paediatric airway management—including difficult intubations and intercostal catheter insertion—is vital for emergency and ICU roles.

Circulation and Vascular Access Skills

Skills such as central and arterial line insertion, external pacing, cardioversion, and pericardiocentesis are all included in this high-stakes domain of practice.

Interpreting the Clinical Skills Table

Categories: Not Observed, Capable (Direct), Capable (Observed)

Each skill listed in the referee check is assessed across three categories:

• Not Observed: The referee has had no opportunity to see the doctor perform this skill.
• Capable (Referee Observations): The referee has directly witnessed the doctor perform the skill to a satisfactory level.
• Capable (Observations of Others): The referee has not seen it directly, but has reliable second-hand reports of the doctor’s capability.

This format provides flexibility while maintaining accountability, particularly in settings where referees may only observe a subset of clinical tasks.

Criteria for Minimum Experience

Certain skill sets, such as psychiatry, internal medicine, and surgery, require a minimum of six months’ registrar-level experience. These benchmarks ensure that the candidate has had sufficient exposure and autonomy to develop clinical judgement in more complex settings.

Understanding the Importance of Each Skill Area

Each domain—whether neonatal care, emergency medicine, or procedural interventions—reflects real-world demands in the NSW health system. Accurate ratings help match locums to appropriate clinical environments and prevent underprepared doctors from being placed in high-risk roles.

Referee Check – Professional Behaviour

Overview and Objectives

Medlo then also focuses on the professional qualities of a doctor. This includes communication skills, team collaboration, reliability, and adaptability. The referee is asked whether they would work with the doctor again and whether any hesitations exist. The form also checks for any known complaints, disciplinary actions, or legal proceedings.

Settings of Evaluation (Ward, ED, Community)

Behavioural evaluations are contextual. A referee might assess a doctor differently in a high-pressure emergency department compared to a slower-paced community setting. This section of the form allows for disclosure of the work setting to help contextualise the behaviour being reported.

Timeframe and Contextual Relevance

Referees indicate the time period over which the doctor was observed. Longer durations generally allow for more accurate and balanced evaluations. The form encourages referees to base their feedback on either direct observation or documented reviews from the clinical team.

Key Professional Behaviour Indicators

Communication and Teamwork

Effective communication with patients and multidisciplinary teams is a cornerstone of safe medical practice. Referees are asked to rate the doctor’s interpersonal skills, including their ability to collaborate, give and receive feedback, and contribute constructively in meetings.

Reliability, Punctuality, and Complaint History

Referees assess whether the doctor consistently arrives on time, follows through on tasks, and has any documented complaints. These indicators may seem basic, but they significantly affect team morale and operational efficiency.

Adaptability to New Work Environments

Given the transient nature of locum work, adaptability is critical. A doctor must quickly familiarise themselves with new systems, policies, and team dynamics. Referees are asked whether the doctor adapted smoothly to new placements.

Legal or Disciplinary Action Checks

One of the most important questions is whether the referee is aware of any ongoing or past disciplinary actions or legal issues. This helps health organisations identify potential red flags before onboarding the doctor.

Risk Mitigation for Public Health Organisations

Why These Checks Matter in Rural/Remote Staffing

Locum doctors often serve in remote or understaffed areas where supervision may be limited. Thorough reference and credentialing checks act as a risk mitigation strategy, ensuring that only appropriately skilled practitioners are deployed. This protects both patients and the health organisation from avoidable adverse events.

Preventing Skill Mismatch in Emergency Situations

Incorrectly placed locums can create critical bottlenecks during emergencies. For instance, placing a doctor without adequate paediatric experience in a hospital with a busy children’s department can compromise care. Referee checks serve as a quality assurance mechanism to align skills with the demands of the specific clinical environment.

Challenges and Limitations of the Assessment Forms

Subjectivity in Referee Evaluations

While structured, referee assessments can still be influenced by personal bias. Differences in rating standards, prior relationships, or workplace politics may colour responses. This is why multiple references—ideally from different work settings—are recommended to gain a balanced perspective.

Gaps in Observational Opportunities

Some referees may not have had the opportunity to observe specific procedures or behaviours directly. In such cases, they must rely on feedback from colleagues or omit an evaluation. This can lead to incomplete assessments, especially in specialised skill areas.

Importance of Multiple Data Points

One referee’s account provides limited insight. NSW Health’s requirement for three references helps triangulate data, identifying consistent patterns across different work settings. This multi-source feedback offers a more holistic view of a candidate’s readiness and suitability.

The Future of Credentialing for Medlo and Helathcare starting with Locum Staff

Digital Tools and AI-based Assessments

Credentialing processes are steadily evolving with the integration of digital tools and artificial intelligence.

Medlo is the one of the only agencies in Australia that checks it’s healthcare staff against the AHPRA database every 24 hours.

Medlo automates document verification, flag inconsistencies, and assess historical reference data for patterns. In the near future, AI may also assist in identifying skill gaps or behavioural red flags, further supporting safe workforce planning.

Integrated National Databases

A unified national credentialing database could streamline the hiring of locums across states and territories. This would reduce duplication of checks and allow real-time access to updated qualifications, referee feedback, and disciplinary records. Such systems could also facilitate automated alerts for lapsed credentials or missing references, improving compliance.

Imagine, a place where you work not only offline, though also online.

Case Study: Dr. Louis Sisk’s Evaluation Summary

Clinical Skills Overview

According to the referee check completed for Dr. Louis Sisk, he demonstrated competence across a wide range of medical skills. These included emergency medicine, paediatrics, and ICU procedures such as manual ventilation and use of vasoactive drugs. He was also noted to have performed competently in general medicine and psychiatry.

Behavioural Observations

The accompanying professional behaviour assessment praised Dr. Sisk for his communication, punctuality, and adaptability. The referee affirmed that they would work with him again without hesitation. No complaints or disciplinary actions were noted, and his ability to integrate into new work environments was rated highly.

Overall Recommendation

The comprehensive reference documents and verified e-signatures supported Dr. Sisk’s suitability for locum work across Australia. His profile met all outlined criteria, and the consistency of feedback across both clinical and behavioural domains reinforced the strength of his candidacy.

Conclusion

Robust referee checks are more than just administrative requirements—they are safeguards that uphold the quality and safety of patient care. For hospitals and other public health organisations, verifying a locum doctor’s skills, behaviour, and experience is essential to maintaining trust in the system.

With increasing demand for locum services—especially in rural and remote areas—thorough credentialing and modern verification tools like digital signatures are becoming indispensable.

As the sector moves towards digitisation and national standardisation, Medlo leads the way having created one of the most sophisticated credentialing systems for effective workforce management.

Don’t take our word for it though — sign up here and find see if you can beat the record of uploading all your documents in less than 4 minutes.