Guidance Matrix: Standard 1

Providers should ensure that their graduates can practice safely and effectively in contexts appropriate to internship* in Australia and Aotearoa New Zealand, through the achievement of the common AMC Graduate Outcomes Statements. Providers should, at the same time, contextualise their medical program outcomes and learning, teaching and assessment* so that providers and their graduates can contribute to the place-based needs of their communities (1.1.2 and 1.1.3). Providers should explain under Standard 1.1: Purpose, how their commitment to producing graduates who are competent for internship and meeting place-based needs relates to their purpose and the design of their program. Specific details of how the program curriculum is designed, mapped and implemented should be explained under Standard 2: Curriculum.

‘Place-based needs’ refers to the needs and characteristics in the health care context of different communities, including but not limited to Aboriginal and/or Torres Strait Islander and Māori* communities, defined by their identification to location and through connection to Country.  Providers should ensure they track and understand the outcomes and impact on health care needs of their program (1.1.2).

Providers should demonstrate their commitment to furthering Aboriginal and/or Torres Strait Islander and Māori peoples’ health equity and participation in their program by explaining how this commitment is reflected in their purpose and strategic vision (1.1.4). Specific initiatives should be explained under other standards related to cultural safety and Aboriginal and/or Torres Strait Islander and Māori health. For example, initiatives related to professional development and support for Aboriginal and/or Torres Strait Islander and Māori staff should be reported under Standard 5.3: Staff appointment, promotion and development.

Documentary evidence could include:

• The purpose statement of the medical education provider and/or program.
• The process of consultation on, development of and implementation of the purpose statement.
• Reports that demonstrate the providers’ interpretation, based on community engagement, of place-based needs, including how this was reached and operationalised.
• Descriptions of how the commitment to furthering Aboriginal and/or Torres Strait Islander and Māori people’s health equity and participation in the program is reflected in the purpose statement and strategic vision.

Interview and observational evidence could include

• Discussions with community stakeholders,  including community controlled health settings and local Aboriginal and/or Torres Strait Islander and Māori community leaders, on their engagement with the provider.
• Discussions with senior staff on how place-based health needs and commitment to health equity are embodied in the program and their responsibilities in this context.
• Discussions with Aboriginal and/or Torres Strait Islander and Māori people participating in the program on the program’s commitment to them.

An example from CSU/WSU Joint Program in Medicine

The Joint Program in Medicine (JPM), a partnership between the School of Medicine (Western Sydney University) and the School for Rural Medicine (Charles Sturt University), endeavours to meet the health needs of under-served communities locally and wherever graduates may work. The partnership is founded on a shared commitment to working with community, guided by a cyclical three-pronged approach: listen to the community; co-design strategic and immediate actions; and co-deliver, co-assess and co-evaluate the actions. The listening is actioned through community representatives on key JPM Committees (for example the Joint Curriculum Committee, Joint Quality and Evaluation Committee). In the School of Medicine there is a dedicated Community Engaged Teaching, Learning and Research Panel;  Community Forums are held at each of the metropolitan and rural Clinical Schools with a board audience of community members and service providers. As well as regular JPM community partner events, community members interview medical school applicants and there is an extensive network of community placement supervisors and community volunteers delivering the flagship Medicine in Context Year 1-3 community placements program. Co-delivery, co-assessment and co-evaluation of initiatives is tailored to each context and community need, for example by training students to identify and discuss community needs during their community placements through weekly small group sessions and clinical placements in community settings.

For example, a community organisation raised the need to support integration of refugee doctors into the medical workforce. Hearing of this need, the Medicine in Context academic lead initiated a co-designed needs assessment of refugee doctors in Fairfield as a community placement activity at the organisation. The students’ work was guided and assessed by the organisation’s placement supervisor alongside the academic team. Following this initial placement, another student placement activity was co-designed to identify stakeholder perspectives of the needs assessment’s findings. The collaboration was reported to the School of Medicine Executive, resulting in other groups from the School’s networks being identified to further develop the initiative. The students were kept informed, so they could see how their contributions had made a wider impact. This experience is now embedded into Medicine in Context teaching to exemplify how students as future doctors can advocate for their local communities.

The model of community-engaged pedagogy permeates across all JPM sites, focusing on listening to community needs and co-design of community placement opportunities.

• LIME Network: LIME Reference Group Orientation and Peer Support Vision Statement (2021)
• LIME Network: Indigenous Health Project – Critical Reflection Tool (2007)
• Jones, R., Crowshoe L., et al (2019). “Educating for Indigenous Health Equity: An International Consensus Statement.” Academic Medicine 94(4): 512-519
• Mazel, O., Anderson I. (2011) “Advancing Indigenous health through medical education.” FoHPE 13(1):1-12
• The Wardliparingga Aboriginal Research Unit of the South Australian Health and Medical Research Institute: National Safety and Quality Health Service Standards user guide for Aboriginal and Torres Strait Islander Health. “Action 1.2: Addressing health needs of Aboriginal and Torres Strait Islander people” (2017)

Different stakeholders* will require different types of engagement on the different issues. People and groups internal to the provider, including staff and students, should be extensively engaged through formal participation in decision-making structures and processes. External partners* should be consulted on decisions, have insight into decision-making processes, and have knowledge of major decisions on the medical program made by the provider. External people and groups with an interest in the process and outcomes of medical training and education, including community groups who experience health inequities and Aboriginal and/or Torres Strait Islander and Māori people and organisations, should be consulted on the decisions that impact on them and should have clear information on how they can engage with the provider. While the level of detail and depth of engagement will depend, members of all three types of stakeholders should be engaged in all of three ways named in standard 1.2.1 (1.2.1).

Providers should explain under Standard 1.2: Partnerships with communities and engagement with stakeholders, the strategic approach and mechanisms for engaging stakeholders at a high level. Specific details of engagement should be explained under other standards. For example, student representation should be explained under Standard 1.3: Governance, and direct involvement of community members in teaching and learning activities should be explained under Standard 5.2: Staff resources.

Providers should demonstrate how they collaborate with communities, including Aboriginal and/or Torres Strait Islander and Māori communities, to understand the strengths and challenges of these communities in support of their health care. Providers should show how they contribute towards meeting their communities’ identified needs, including through collaboration with those communities (1.2.1).

Not all partnerships with the categories of organisations named in standard 1.2.2 will be supported by formal agreements. In determining whether a partnership should be supported by a formal agreement, providers should consider the operational, legal, financial and reputational risk of having a partnership without an agreement. Providers should generally secure formal agreements with services that provide structured clinical placements for their students (1.2.2).

To ensure that partnerships with relevant Aboriginal and/or Torres Strait Islander and Māori people and organisations are ‘mutually beneficial’, providers should demonstrate how those partnerships enhance the social accountability and acceptability of the program in line with the expectations of the community. Aboriginal and/or Torres Strait Islander and Māori people and organisations should be engaged through consultation, co-design and inclusion in governance structures, as appropriate (1.2.3).

To ‘promote community sustainability’, providers should not take more resources from Aboriginal and/or Torres Strait Islander and Māori people and organisations than they provide. Providers may achieve this by, for example, paying community controlled health settings to at least cover expenses incurred for placement spaces, funding or contributing to capital works, and/or providing professional development or training opportunities (1.2.3).

Documentary evidence could include:

• Correspondence, schedules, reports and outcomes related to community engagement events such as focus groups or town hall meetings.
• Terms of reference, agendas and minutes from stakeholder representation bodies/reference groups.
• Descriptions of key partnerships that support the education and training of medical students.
• Organisational charts that detail the input of stakeholders into the governance of the program, including stakeholder membership on relevant boards and committees.
• Charts/tables of the provider’s representation on relevant stakeholder boards and committees.
• Memoranda of Understanding, placement agreements, and other formal agreement documents between the provider and partner organisations; particularly relating to consultations, joint appointments and standing committee membership.
• Descriptions of the mutual benefits providers and Aboriginal and/or Torres Strait Islander and Māori people and organisations provide to each other.
• Samples of written feedback from student and communities collected through provider feedback mechanisms.

Interview and observational evidence could include

• Discussions with community members who experience health inequities on the provider’s engagement of them.
• Discussions with other stakeholders on the efficacy of their partnerships with the provider.
• Discussions with students and staff on their involvement in community engagement activities.
• Discussions with Aboriginal and/or Torres Strait Islander and Māori people and organisations’ on the nature of their partnerships with the provider.

An example from the University of Western Australia Medical School

The integration between RCS WA and WA Country Health Service (WACHS) is longstanding and encompasses supervision and education for both medical students and junior medical officers (JMO).

This partnership has facilitated the creation of internship positions in RCS WA sites that accept final year medical students (e.g., Albany, Bunbury, and Geraldton).

Clinical placements are closely matched with supervisor capacity, student numbers, JMO numbers and training opportunities. The scale of the initiative has been determined by capacity for clinical training and supervision in rural sites.

Working closely with the rural workforce agency (Rural Health West, RHW) has led to several projects, including a multi-organisational collaboration to develop Health Professional Networks in each region of rural WA, for educational and networking opportunities, support for rural medical students at medical conferences, and provision of scholarships for rural electives.

The creation of academic positions through UWA and RCS WA has enabled the growth of health and medical research initiatives that have engaged with community groups and been informed by rural and indigenous peoples’ health priorities.

The collaborative outlook from RCS WA has facilitated partnerships between the UWA Medical School and the Medical Schools of the University of Notre Dame, Fremantle, and Curtin University. RCS WA now manages the selection, supervision, and clinical placements to rural sites of medical students from all three WA Medical Schools.

• AHRA Women’s Health Research, Translation & Impact Network: Webinar – Consumer and Community Involvement (CCI) Tap into local councils to connect with underserved populations (2023)
• ACSQHC: NSQHS Standards – Partnering with Consumer Standard. “Partnering with consumers in organisational design and governance” (2021)
• The Wardliparingga Aboriginal Research Unit of the South Australian Health and Medical Research Institute: National Safety and Quality Health Service Standards user guide for Aboriginal and Torres Strait Islander Health. “Action 2.13: Working in partnership” (2017)

In documenting the governance structure, the provider should clearly define and document for each committee or group:

• The composition/membership.
• The terms of reference.
• Scope of responsibilities and decision-making authority
• Reporting relationships (1.3.1).

‘Authority and capacity to… improve the program’ refers to governance arrangements that are responsive when opportunities, needs and deficits are identified. This includes a timely process for identifying and responding to program requirements (1.3.2).

‘Effective academic oversight’ refers to the academic governance of the medical program being independent and able to make and implement decisions autonomously, such that the provider can consistently ensure integrity and quality of the core activities of learning, teaching, research and scholarship; and can manage challenges to those activities (1.3.3).

Students being ‘supported to participate’ includes:

• An environment that is genuinely welcoming to student perspectives.
• Representation that is inclusive of all groups in the student cohort
• Representation is responded to appropriately, with action taken based on student engagement (1.3.4).

Aboriginal and/or Torres Strait Islander and Māori* staff and clinical supervisors should always be genuinely included in governance processes that relate to Aboriginal and/or Torres Strait Islander and Māori people, including decision-making processes related to learning, teaching, assessment*, evaluation*, resourcing, cultural safety* and wellbeing. The participation of Aboriginal and/or Torres Strait Islander and Māori staff and clinical supervisors in program governance should be facilitated in a manner that acknowledges cultural loading, such as by allowing flexible participation options and appropriately remunerating staff based on their level of participation in governance, and allows meaningful input into all key decisions. A well-supported Aboriginal and/or Torres Strait Islander and Māori governance committee and/or an Aboriginal and/or Torres Strait Islander and Māori education unit, with appropriate resources, sufficient independence and relevant authority, is usually required to ensure meaningful participation in governance and decision-making processes (1.3.5).

Documentary evidence could include:

• Detailed organisational charts, including reporting lines, outlining the relationships, responsibilities and decision-making powers for bodies (e.g. committees, panels, boards, working groups etc.) involved in medical program governance.
• Current terms of reference, membership lists, and recent agendas and minutes for governance bodies.
• Descriptions of primary organisational units for teaching and research that contribute to the program, including the organisational units such as clinical schools responsible for organising clinical teaching.
• The job titles of, names of, and brief role descriptions for the key role holders for primary organisational units.
• Descriptions of decision-making and delegation procedures of key governance bodies, including flow charts of reporting relationships.
• Policies and plans for renewal of key governance bodies.
• Descriptions of change management/ implementation and conflict resolution processes for key governance bodies.
• Case studies of governance processes in practice, for example as used for a recent significant program, curriculum or policy change decision, or to identify and meet a resourcing need.
• Descriptions of how student representation is achieved, the range of bodies on which students are represented. Include the procedure for selecting student representatives from across the cohort and program sites, and examples of how the program addresses systemic concerns raised by student representatives.
• Case studies of responses or actions taken as a result of engagement of students in governance and decision-making in the medical program.
• List of the medical student groups and societies, and the names of student leaders.
• Descriptions and case studies of how Aboriginal and/or Torres Strait Islander and Māori staff and clinical supervisors participate in governance, such as through an Aboriginal and/or Torres Strait Islander and Māori governance committee and/or Aboriginal and/or Torres Strait Islander and Māori education unit.
• Numbers and role of students who are members of governance bodies.
• Numbers, level of appointment and FTE of Aboriginal and/or Torres Strait Islander and Māori staff and clinical supervisors who are members of governance bodies.
• Conflict of interest policies and case studies of how these are managed in practice.

Interview and observational evidence could include

• Discussions with staff on how governance structures work, are communicated about, and are participated in.
• Discussions with students on the efficacy of student representation in the program.
• Discussions with Aboriginal and/or Torres Strait Islander and Māori academic staff and clinical supervisors’ on their participation in governance and decision-making.

No examples at this time.

• TEQSA: Guidance note – Academic governance (2023)

‘Dedicated’ roles refer generally to the role holder being able to focus on that role through minimising additional roles and external responsibilities (1.4.2 and 1.4.3).

For both the leadership of the medical program and the leadership of the Aboriginal and/or Torres Strait Islander and Māori health aspects of the program, ‘appropriate authority and resources’ refers to the leadership being integrated into the program rather than isolated, having financial and staff resources to fulfil its obligations, and being appropriately placed in the governance structure to be able to steer and influence decision-making (1.4.3 and 1.4.4).

Along with (a) senior leadership role(s) covering responsibility for Aboriginal and/or Torres Strait Islander and Māori health, the medical program leadership team should include medical educationalists, clinicians and professional staff. The size and nature of the team will depend on the size of the student body, the structure of the program and the range of community and health service relationships to be built and maintained (1.4.3).

‘Information about the medical program, its policies and its requirements’ including ‘information necessary to support delivery of the program’ that should be available to stakeholders includes documentation relating to (note this list is outlining information which should be accessible, to a greater or lesser extent, to the public, applicants, students, staff and clinical supervisors. Not all this information needs to be provided to the AMC as evidence under this standard, instead providers need some description or evidence of its availability to these stakeholders):

• Selection processes, including appeals.
• Assessment philosophy or strategy, principles practices and rules.
• Assessment and progression requirements.
• Assessment marking methods.
• The design and structure of the curriculum and learning objectives/outcomes.
• Alignment of learning objectives/outcomes with learning, teaching and assessment activities.
• The outcomes of evaluation and continuous improvement activities.
• Bullying, harassment, racism and discrimination policies.
• Student wellbeing strategy or strategies.
• Inclusion strategy or strategies.
• Reasonable adjustments/accommodations policies.
• Professionalism and fitness to practice policies and procedures.
• Standards for student conduct and procedures for disciplinary action.
• Conflict of interest policies (1.4.6).
• Different audiences will require different types and levels of access to information. Providers should consider whether the information is relevant to the audience. For example, detail on the broad features of selection processes would be particularly relevant to applicants, while staff involved in selection processes should have detailed information on what is expected of them. While documentation that includes personally identifiable information and commercially sensitive details should be treated with care and consistent with legal and ethical obligations, providers should aim for transparency when determining if information should be made available and accessible. When information is available to the public through the provider’s website, it should also be easy to navigate to and find the information (1.4.6).

Documentary evidence could include:

• Descriptions of the budgetary relationship between the program and the broader (university) institution, and how this has changed.
• Summary budget documents that describe major sources of revenue and cost centres and how these have changed over time.
• Budget projections for the next several years.
• Impact analyses of changes to the budget.
• Descriptions of how research funding and equipment, and capital funds, are distributed.
• Policy or statement that defines the responsibilities of the academic head of the program.
• Current position descriptions for key leadership roles and brief biographies of the people who fill those roles.
• Current position descriptions for senior leadership role(s) covering responsibility for Aboriginal and/or Torres Strait Islander and Māori health and brief biographies of the people who fill those roles.
• Budget overview for operationalising Aboriginal and/or Torres Strait Islander programs (e.g. cultural safety training, scholarships, workshops, guest speakers, etc.).
• The schedule of delegations, including financial delegations.
• Descriptions of internal quality assurance mechanisms to assess the level of qualification against national standards.
• Correspondence with or reports from TEQSA or NZQA and any other relevant external accreditation documentation that indicates the status of the program level of qualification as externally accredited or self-accredited.
• Links to publicly available information about the medical program, key policies and requirements.
• Descriptions of how information about the medical program, key policies and requirements are provided to applicants, students, staff and clinical stakeholders.

Interview and observational evidence could include

• Discussions with medical program leadership team on the authority they are able to exercise and resources they are able to direct.
• Discussions with Aboriginal and/or Torres Strait Islander and Māori health leader(s) on their responsibilities in the program, the authority they are able to exercise and resources they are able to direct.
• Discussions with staff on the integration of the medical program leadership team, including the Aboriginal and/or Torres Strait Islander and Māori health leader(s), in the governance structure and staff views of program leadership team independence, influence and authority.
• Discussions with program and provider business managers on the function of delegations and accountability procedures.
• Discussions with internal and external stakeholders on the accessibility and awareness of key information.

An example from University of Melbourne, Melbourne Medical School

Academic and financial autonomy of the MD program is supported by the Department of Medical Education governance structure introduced in 2019. Through an expressions-of-interest process in 2018, staff from within the Medical School applied for and were appointed as directors of specific areas related to the Melbourne MD with responsibility for their portfolios. Most have an active program of scholarly research in their directorate which supports innovation, builds capacity and contributes to the rigor of the innovations they champion.

The key committee is the MD Governance Committee, which is chaired by the Head of Melbourne Medical School, includes two elected student representatives, and two stakeholders from outside the Department of Medical Education (currently a professor of Anatomy and Cell Biology from the School of Biomedical Sciences and a professor of anaesthetics. Directors of the DME MD portfolios attend meetings to provide information to the committee. The committee receives proposals for course improvements from the subcommittees reporting to it (particularly MD Redesign Committee and MD Operations Committee), as well as evaluation reports from the Evaluation and Quality Directorate.

By the time proposals for change come to the MD Governance Committee for approval, they have been developed by the directors with most expertise in the area, well considered for educational appropriateness (through the MD Redesign Committee) and feasibility (through the MD Operations Committee), as well as demonstrated the need for the change through previous evaluations. This means that there are rarely conflicts about a change being suitable for implementation, although proposals for significant or particularly innovative changes are often tied to a deliberate evaluation framework.

One recent example is the conversion of the MD program from standard grading to pass fail grading. The Director of Assessment produced several documents outlining the innovation and the rationale behind it – a MD Redesign Assessment Strategy, Proposal for Pass Fail Grading, and a Pass/Fail Grading FAQ.  Each of these documents drew on the existing literature, research within the MD, and our own evaluation data to provide the rationale for change.  The work was interrogated and refined through our own governance pathways and finally presented to the relevant Faculty and University committees for review and ultimate approval.

The reporting relationships of the MD committees at the time of that change can be summarised as:

There are no resources at this time.