Application for Interruption to CICM Training

This form is for any Trainees who require an interruption to their CICM Training Program.

Interruptions to training will be reviewed and approved in accordance with the current Regulations. Please ensure you have reviewed the Interrupted Training Regulations prior to submitting this application.

Please note the following prior to completing this form:

1. Trainees may interrupt their CICM training for up to 3 years (156 weeks) over the course of their training program. A maximum of 1 year (52 weeks) can be approved at any time.  Parental leave will not contribute to the maximum 3-year allowance.
2. Periods of interruption to training will contribute to the maximum timeframes permitted for completion of training (12 years), with the exception of parental leave.
3. No period of interruption will be approved without appropriate third-party supporting documentation.
4. If you are eligible for a concession for your interruption to training this will be applied upon approval. You do not need to apply for a concession separately.
5. Specialist trainees who step off the training program (interrupted training) but continue to practice medicine will need to join a CPD home and are responsible for recording CPD for the period of their interruption. Contact cpd@cicm.org.au to discuss your situation.

Types of third-party supporting evidence can include:

1. Treating Physicians Letter/Notice of Confinement/Employer confirmation of parental leave
2. Medical Certificate/Carer’s Certificate
3. Letter from SOT
4. Locum contract (redact personal and salary information)
5. Employment contract (if site not accredited for training/working less than 0.4 FTE)
6. Evidence of travel/relocation
7. Confirmation of leave from Human Resources department
8. Confirmation of enrolment of additional Training Program
9. Statutory Declaration*
   
   *In the event that sufficient evidence cannot be sourced a Statutory Declaration may be accepted.