A recent query about a deceased grandfather’s membership of the College prompted me to ponder the institution’s Fellowship. The enquirer explained that family lore held their father to be a Foundation Fellow, but I could find no record of his name on the College Roll or in the archival listings of Fellows. The answer to the grandfather's status was eventually revealed in a handwritten register held in the Council Room of 145 Macquarie St. His name was listed but crossed out, with a note pencilled beside it saying 'resigned Fellowship 8.4.1941'.

If this doctor was no longer considered a Fellow, I wondered whether the title of Foundation Fellow is permanent—once conferred, does it always remain?

Foundation Fellowship of the newly formed College was by election with many drawn from the membership of the precursor organisation, the Association of Physicians of Australasia. Typically, those elected had to have 'practised exclusively internal medicine or related specialties, held an honorary position at a public hospital and were of good character'.

For its first forty years, the College maintained a two-tier structure consisting of Fellowship and Membership, adopted from the Royal College of Physicians of London.

Under this system, all candidates would sit for the general MRACP examination. They would then practice as a physician or go overseas and do training, but there were no examinations for Fellowship. Instead, those with an MRACP who wanted to convert to a FRACP had to be nominated by a Fellow after submitting proof that they held a position as a consultant in a teaching hospital for at least three years.

Prior to the phasing out of its Membership (in 1978), the College Council had decided in 1968 to appoint two committees:
(a) a Committee on Physician Training to consider:
(i) the training and recognition of a specialist physician;
(ii) the role of Membership and Fellowship in relation to the foregoing; and
(b) a Committee on Hospital Accreditation to consider the question of hospital accreditation for the purposes of the training of physicians.

Eventually, in 1973, two phases of training were recognised:
(i) basic training, in which a trainee would acquire a broad basis of knowledge and of skills in the principles and practice of internal medicine or paediatrics;
(ii) advanced training, which might be undertaken in general medicine, in paediatrics or in one of the specialties of internal medicine. After basic training for a minimum period of three years following the intern year, trainees were required to pass a written and a clinical examination (Part 1 FRACP). If successful in that examination, trainees would enter a period of advanced training, which would extend for a minimum of three years. Having completed that training, the trainee would be awarded Fellowship of the College (FRACP) without further examination.

Once new cohorts began obtaining the FRACP through examination and specialty training, all existing MRACPs were elevated to FRACP to ensure equity.

From 1988, the Part 1 examination could be taken, in addition to the end of basic training, during any year of advanced training. However, admission to the Fellowship of the College still required the completion of basic training and of advanced training and a pass in the FRACP examination, which continued to be a broadly based examination in internal medicine and paediatrics.

So what of our original query - is he still considered to be a Foundation Fellow, if not an actual Fellow? The original Articles of Association of the College define "Foundation Fellow" as 'a member of the Association of Physicians in Australasia who, before the expiration of six months from the incorporation of the College, agreed in writing to become a member of the College and any such other person who was elected by the Council to Fellowship of the College within six months of the date of incorporation'. Whether the designation is considered honorary or contingent on ongoing Fellowship is yet to be confirmed definitively but investigation will continue.