Guidance Matrix: Standard 2

To ensure that medical program outcomes* are ‘consistent with’ the areas outlined, providers should demonstrate:

• How each AMC graduate outcome statement maps to medical program outcomes. (The provider’s detailed curriculum mapping and assessment* blueprinting documents should be explained under Standard 3.1: Assessment design).
• How the general requirements of internship* in Australia and Aotearoa New Zealand, as well as the specific requirements of local prevocational training providers* map to medical program outcomes.
• How the health needs of communities served relate to the medical program outcomes (2.1.1).

‘Assessment outcomes’ relate to student performance on assessments and performance related to progression points (2.1.2). Details of the system of assessment should be explained under Standard 3: Assessment.

Providers should ensure that no student is disadvantaged or materially affected by lack of access to learning resources and supervision by the site of education (2.1.2).

Documentary evidence could include:

• The medical program outcomes.
• Mapping documents of AMC graduate outcome statements to medical program outcomes.
• Mapping documents of program outcomes to learning objectives/outcomes for themes and/or stages of the program.
• Formal agreements, correspondence or other documentation related to prevocational training provider engagement and collaboration.
• Correspondence or other documentation related to community engagement and collaboration such as written consultation, community meetings, focus groups or town halls.
• Descriptions of how prevocational training provider requirements and community needs are considered when developing medical program outcomes, such as consultation documents.
• Descriptions of learning resources and supervisory quality at each site, including any innovation or unique opportunities at sites.
• Descriptions of measures taken to ensure equitable access to learning and supervisory experiences and appropriate resources in each learning environment.
• Outcomes of analyses of assessment performance for students placed in different program sites.

Interview and observational evidence could include:

• Discussions with community stakeholders on their involvement in determining medical program outcomes.
• Discussions with prevocational training providers on their collaboration and engagement with the provider on medical program outcomes.
• Discussions with staff and students at different education sites about the quality of and access to learning resources and supervision.
• Discussions with staff and clinical supervisors about orientation, training and professional development opportunities across different sites.

There are no examples at this time.

There are no resources at this time.

Some important ‘educational principles’ that providers should consider in their programs could include:

• Horizontal and vertical integration.
• Constructive alignment.
• Articulation with subsequent stages of medical training.

Concepts such as:

• Flexible learning.
• Reflective learning.
• Culturally safe learning.
• Self-regulation.
• Technology-enhanced learning.
• Role modelling.

Also connect with these educational principles (2.2.1).

Aboriginal and/or Torres Strait Islander and Māori health content should be horizontally and vertically integrated throughout the curriculum, based on a framework set out in the Aboriginal and/or Torres Strait Islander and Māori health curriculum (2.2.2 and 2.2.3).

The Aboriginal and/or Torres Strait Islander and Māori health curriculum should include all aspects of Aboriginal and/or Torres Strait Islander and Māori health and cultural safety* in the Graduate Outcome Statements, including:

• Aboriginal and/or Torres Strait Islander and Māori approaches to health and wellbeing, including social and emotional determinants of health.
• Impacts of colonisation, racism and bias on health outcomes, and the role of anti-racism in addressing these impacts.
• The history, culture and health of Aboriginal and/or Torres Strait Islander and Māori peoples
• Interacting with Aboriginal and/or Torres Strait Islander and Māori patients in a culturally safe manner (2.2.3).

A variety of clinicians and academics will be involved in implementing the Aboriginal and/or Torres Strait Islander and Māori health curriculum, however the curriculum should be designed under the guidance of, and led by Aboriginal and/or Torres Strait Islander and Māori health experts. The Aboriginal and/or Torres Strait Islander and Māori leadership role holder(s) (see standard 1.4.4) should be involved in the curriculum design and leadership process (2.2.3).

For the curriculum to ‘enable and integrate… professional behaviours to ensure a safe transition to subsequent stages of training’ and ‘enable graduates to demonstrate achievement of all medical program outcomes and AMC outcome statements’, providers should include learning about professionalism in the curriculum (2.2.6 and 2.2.8).

The AMC does not prescribe a minimum duration for medical programs. In Australia, bachelor’s and master’s degrees are typically 3-4 years, separately or in combination, as outlined in the Australia Qualifications Framework. The New Zealand Qualifications Framework sets out the expectation that bachelor’s degrees will be at least 360 credits (60 credits per semester with two semesters per year, typically over three years), and the minimum entry requirement for a master’s degree is a bachelor’s degree (2.2.8).

To be ‘effectively communicated’, students and staff should be able to easily access and should understand learning outcomes relevant to their learning and teaching activities, in a format that is straightforward to navigate, locate and apply. For AMC accreditation purposes, the program should report on learning outcomes. Many programs also have learning objectives as a more granular component of learning outcomes. Programs do not necessarily need to report on learning objectives but should explain how these fit within the broader curriculum framework (2.2.9).

Documentary evidence could include:

• Curriculum planning and/or policy documents that describe the guiding educational principles and how these are applied.
• Detailed descriptions of the curriculum structure, including curriculum diagrams, mappings and scheduling (e.g. of clinical placements).
• Outline of program structure including the identification of individual components within each year, and how the medical program is organised by year/terms/semesters/phases; including relevant schematics and an annual program calendar.
• The Aboriginal and/or Torres Strait Islander and Māori health curriculum document.
• Descriptions of how the Aboriginal and/or Torres Strait Islander and Māori health curriculum is developed and reviewed, including the key expert(s) involved.
• Descriptions of how Aboriginal and/or Torres Strait Islander and Māori health content is integrated throughout the overall curriculum, including how different disciplines of health integrate clinical aspects related to Aboriginal and/or Torres Strait Islander and Māori health.
• Summary of the provider’s research plan and major research directions.
• List of relevant research organisations affiliated with the provider.
• Descriptions of opportunities for medical students and staff to engage in research in the program.
• Case studies of how research informs learning, teaching and assessment in the program.
• Descriptions of how the Graduate Outcome Statements are achieved by graduation, through mapping of learning outcomes/objectives for each year/phase of the program.
• Descriptions of how the program design ensures students evaluate and take responsibility for their own learning, and are prepared for lifelong learning.
• Descriptions of processes to ensure alignment of planning, governance, and review mechanisms.
• Descriptions of how professionalism is learnt and developed in the curriculum, and linked with learning, teaching and assessment activities.
• Systems for teaching or other educational awards for staff.
• Documents describing the program provided to students and staff
• Descriptions of how overall medical program outcomes* and other relevant learning outcomes/objectives are communicated to students, staff and clinical supervisors.
• Descriptions of avenues for students to pursue studies of choice within the program.

Interview and observational evidence could include

• Discussions with staff responsible for curriculum development and review on the overall curriculum philosophy.
• Discussions with staff in curriculum area or year/phase leadership roles on the implementation of the curriculum.
• Discussions with the Aboriginal and/or Torres Strait Islander and Māori leadership role holder(s) and other staff responsible for development and review of the Aboriginal and/or Torres Strait Islander and Māori curriculum on development and review processes, and integration with the overall curriculum.
• Discussions with students and teaching staff on their understanding of the formal curriculum documentation and learning outcomes.
• Discussions with research staff on the provider’s research and scholarship activities and how this informs learning, teaching, research and scholarship within the program.
• Discussions with clinical supervisors on medical students’ achievement at different stages of the program.

There are no examples at this time.

• Australian Indigenous HealthInfoNet (2023)
• LIME Network: Good Practice Case Studies (2012-2019)
• Lowitja Institute: Deficit Discourse and Strengths-Based Approaches – Changing the Narrative of Aboriginal and Torres Strait Islander Health and Wellbeing (2018)
• The University of Western Australia: Good Spirit Good Life (2020)
• Australian Commonwealth Department of Health and Aged Care: Aboriginal and Torres Strait Islander Health Curriculum Framework (2012)
• CDAMS/MDANZ: Indigenous Health Curriculum Framework (2004)
• MDANZ and AIDA: National Medical Education Review – A review of the implementation of the Indigenous Health Curriculum Framework and the Health Futures report within Australian medical schools (2012)
• MDANZ: Research in the Medical Curriculum Volume 1 – A Window on Innovation and Good Practice (2022)
• MDANZ: Professionalism and professional identity of our future doctors (2021)

‘Fit-for-purpose’ learning and teaching methods means that the selections of methods are aligned with the intended learning outcomes, methods of assessment*, and the intended purpose of learning and teaching (2.3.1).

For providers to ensure that learning and teaching methods create opportunities for students for partnership with patients*, providers themselves should establish partnerships* with patient communities (2.3.2). Details of these partnerships should be explained under Standard 1.2: Partnerships with communities and engagement with stakeholders*.

‘Experience of interprofessional learning’ which ‘foster[s] collaborative practice’ involves a coherent program of planning learning activities, undertaken with students from other relevant health professions, where capabilities required for collaborative practice are deliberately developed.

The ’required level’ of clinical skill development is the level that allows graduates to safely achieve the medical program outcomes* (2.3.5).

Students’ ‘opportunities to learn about the different needs of community groups who experience health inequities* and Aboriginal and/or Torres Strait Islander and Māori* communities’ should involve members of those communities in learning, teaching, assessment and/or co-design. The ‘different needs’ of these communities includes consideration of intersectionality (2.3.6).

Learning and teaching that ‘is culturally safe’ is informed by Aboriginal and/or Torres Strait Islander and Māori knowledge systems and is spiritually, socially, emotionally and physically safe for learners and teachers. Providers should consider the differing needs of Aboriginal and/or Torres Strait Islander and Māori learners engaging with content, Aboriginal and/or Torres Strait Islander and Māori staff teaching, and Aboriginal and/or Torres Strait Islander and Māori communities interacting with the program. All identities are valued, and there is mutual respect and sharing of meanings and knowledges (2.3.7).

‘Aboriginal and/or Torres Strait Islander and Māori knowledge systems’ that providers should consider in their program include:

• Social and emotional wellbeing.
• Strengths-based discourse.

While the AMC does not specify minimum contact hours or weeks that medical students must spend in learning environments – clinical, campus, community, laboratories etc. – an ‘extensive range of face-to-face experiential learning experiences’ means that a meaningful proportion of the medical program should be delivered in-person, particularly clinical learning (2.3.8).

All students should be able to undertake a range of ‘experiential learning experiences’. Providers should specify which students undertake which learning experiences.  All students should have opportunities to undertake experiential learning in both inpatient and outpatient settings. It is noted that not all students will have the opportunity to undertake all experiences offered by the program (2.3.8).

Dedicated end-to-end rural pathways will meet this standard if students within these pathways have sufficient opportunities related to healthcare in a variety of clinical disciplines, relevant across the life span, and situated in a range of settings including health promotion, prevention and treatment (2.3.8).

That learnings experiences are ‘undertaken in a variety of clinical disciplines’ refers to clinical placements being planned and structured to enable students to demonstrate achievement of learning outcomes across clinical disciplines in both general and speciality medicine and surgery, as well as women’s health, child and adolescent health, mental health and primary care. Placements may be integrated (particularly in rural settings) and do not need to be specific to a clinical discipline, but providers should be able to demonstrate how students will gain experience in these clinical disciplines throughout their clinical learning placement (2.3.8).

In pre-internship programs*, the learning needs of students are explicit and central, and the role of the student, as well as their scope of practice within the clinical team, is clearly defined and articulated. The AMC does not specify the content of or minimum contact hours or weeks for pre-internship programs. The provider should be able to justify the content and length of the pre-internship program as sufficient to facilitate a safe transition to internship through consolidation of clinical knowledge and provision of strategies and skills relevant to internship. Providers and training sites should be partners* in ensuring the quality of student learning, assessment and support. Prevocational training providers* are key stakeholders to engage while designing pre-internship programs (2.3.9).

Documentary evidence could include:

• Descriptions of how of learning and teaching methods are selected and used during the program to ensure they are aligned to learning outcomes and assessment.
• Agendas and minutes from curriculum/education committees/working groups that demonstrate how learning, teaching and assessment methods are designed and implemented to be fit-for-purpose.
• Curriculum map which describes the nexus of learning, teaching and assessment methods.
• Examples of how student time is allocated to different learning and teaching formats, such as lectures, simulation sessions, tutorials, laboratory learning, and clinical immersion sessions, during different stages of the program.
• Descriptions of the learning and teaching methods employed to develop students’ clinical reasoning judgement during different stages of the program.
• Descriptions of interprofessional learning activities and initiatives.
• Documentation of supervision arrangements and/or scope of practice agreements for students at different phases of the medical program.
• Descriptions of opportunities to learn about the differing needs of community groups who experience health inequities and Aboriginal and/or Torres Strait Islander and Māori communities.
• Correspondence or other documentation related to community member involvement in learning, teaching, assessment and/or co-design.
• Descriptions of the how learning and teaching is informed by Aboriginal and/or Torres Strait Islander and Māori knowledge systems and medicines.
• Evaluation report of the cultural safety of learning and teaching and acceptance of teaching around Aboriginal and/or Torres Strait Islander and Māori knowledge systems and medicines.
• Descriptions of the criteria for selection and review of clinical placements including how the placements allow students to experience a range of types of care that support student achievement of the AMC Graduate Outcome Statements.
• Descriptions of how students are assigned to clinical placements.
• The full list of placement providers demonstrating the inclusion of a range of placement settings.
• Information in tabular form, for each clinical site, of the numbers of students placed and in what department/speciality, broken down by each cohort of the program.
• Descriptions of the strategies the provider follows to ensure an extensive range of face-to-face experiential learning opportunities across clinical disciplines, the life span, and in a range of types of care and geographically diverse settings.
• A diagrammatic or other representation of the student journey demonstrating the range of placements that a student will have during their program.
• Descriptions of the design and implementation of the pre-internship program.

Interview and observational evidence could include:

• Discussions with students on the quality of their clinical learning opportunities.
• Discussions with community stakeholders on their involvement in learning, teaching, assessment and/or co-design in the program, and the cultural safety of these activities.
• Discussions with Aboriginal and/or Torres Strait Islander and Māori students and staff on the cultural safety of learning and teaching.
• Discussions with Aboriginal and/or Torres Strait Islander and Māori students and mainstream students on the content of Aboriginal and/or Torres Strait Islander and Māori knowledge systems and medicine that is taught.
• Discussions with clinical supervisors on supervision and scope of practice arrangements for students.
• Discussions with clinicians or tutors from other health professions on their involvement in the medical program.
• Observation of key learning and teaching activities.

There are no examples at this time.

Curtis, E., R. Jones, D. Tipene-Leach, C. Walker, B. Loring, S.-J. Paine and P. Reid (2019). “Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition.” International Journal for Equity in Health 18(1): 174.

Harris, R., D. Cormack, J. Stanley, E. Curtis, R. Jones and C. Lacey (2018). “Ethnic bias and clinical decision-making among New Zealand medical students: an observational study.” BMC Medical Education 18(1): 18.