Guidance Matrix: Standard 4

If the provider intends to increase the size of the student intake, the provider should have plans and associated resources in place to ensure the current student experience and outcomes of the medical program* are not negatively impacted (4.1.1).

In medicine and medical education, there is significant underrepresentation of Aboriginal and/or Torres Strait Islander and Māori people, people from rural backgrounds and people from equity groups*. The aim of targets and strategies for recruitment and retention of these groups should be to reduce and ultimately eliminate the underrepresentation of these groups in medicine and medical education. These strategies and supports should be clearly defined, appropriate to the differing needs of these communities, and aligned with community expectations (4.1.2 and 4.1.3).

Providers should define the ‘equity groups’ that are targeted and supported to participate in the medical program, in partnership with stakeholders and local communities and with reference to relevant evidence (4.1.2 and 4.1.3). See the glossary definition of equity groups.

‘Defin[ing] the nature of the student cohort’ also includes setting the numbers of international students and domestic students, including numbers through different funding pathways, that the provider targets to form student cohorts (4.1.2).

‘Infrastructure… for student retention and graduation’ refers to the physical infrastructure and technology which support student success for Aboriginal and/or Torres Strait Islander and Māori students, students with rural backgrounds and students from equity groups. ‘Supports’ for these purposes refers to the accessible services named in standard 4.2.2 and additional health and learning support mentioned in standard 4.2.3, but also community networks, dedicated staffing, professional development opportunities (such as resourcing to attend key conferences and networking events) and others that are connected to strategies for recruiting these students (4.1.3). Providers should explain under Standard 4.1: Student cohorts and selection policies, how the available infrastructure and support is strategically linked to the strategies for recruiting Aboriginal and/or Torres Strait Islander and Māori students, students with rural backgrounds and students from equity groups. The specific details of support services should be explained under Standard 4.2: Student wellbeing. Specific details of physical facilities and ICT infrastructure should be explained under Standard 5.1: Facilities.

A provider that ‘supports inclusion’ of students with disabilities:

• Ensures that policies, procedures and support mechanisms are based on the principles of equity, inclusion and diversity.
• Works to provide accessible physical, educational and social environments within program sites.
• Provides appropriate staff resources and expertise such as a disability liaison officer.

Considers how to reduce barriers to entry for the medical program, for example by developing a disability entry pathway into the program (4.1.4).

Documentary evidence could include:

• Numbers of students, including by cohort and by demographic category and other characteristics and qualities relevant to program and provider context and communities that it serves, for at least the prior five years. These numbers should also be broken down by entry pathway and type of student (e.g. in Australia, Commonwealth Supported Places, Bonded Medical Places, full fee-paying domestic and international students).
• Details of student attrition rates, including the reasons for attrition, by cohort and by demographic category that the provider tracks, for at least the prior three years.
• The selection policy or policies, including information on governance and appeals.
• Documentation around the admission process.
• Summary table of selection steps, instruments, weightings and timelines; including how any standardised admission tests such as the GAMSAT and MCAT are used as part of the selection process.
• Descriptions of how resources such as teaching staff, physical facilities including teaching spaces, and available numbers of placements are sufficient for the size of the student intake. If there are plans to increase the size of the student intake, descriptions of how these resources are or will be sufficient for the planned intake size.
• The strategy for recruiting Aboriginal and/or Torres Strait Islander and Māori people, people with rural backgrounds and people from equity groups, including details on targets.
• A description of the infrastructure and support provided to applicants and students who are Aboriginal and/or Torres Strait Islander and Māori, from rural backgrounds and from equity groups.
• A description of policies, resources, staff and physical infrastructure that support applicants and students with disabilities.
• Descriptions of initiatives that increase the participation of Aboriginal and/or Torres Strait Islander and Māori people, people with rural backgrounds and people from equity groups in the medical program; particularly initiatives based on an analysis of cohorts of students.

Interview and observational evidence could include:

• Discussions with staff responsible for admissions on the admissions strategy, including the (part of the) strategy specific to Aboriginal and/or Torres Strait Islander and Māori people, people with rural backgrounds and people from equity groups.
• Discussions with community stakeholders, including Aboriginal and/or Torres Strait Islander and Māori communities, on how they are involved in developing and implementing the admissions strategy.
• Discussions with Aboriginal and/or Torres Strait Islander and Māori students and support staff on the efficacy of support that enables the recruitment and retention of Aboriginal and/or Torres Strait Islander and Māori people, people with rural backgrounds and people from equity groups.

There are no examples at this time.

LIME Network: Pathways Into Medicine (no date)

AIDA: Healthy Futures – Defining best practice in the recruitment and retention of Indigenous medical students (2005)

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)

Curtis, E., Townsend S. and Airini (2012). “Improving Indigenous and ethnic minority student success in foundation health study.” Teaching in Higher Education 17(5): 589-602.

A provider’s strategy to support medical student wellbeing and inclusion should include:

• An identification of the risks to student wellbeing and inclusion, including those emerging from institutional structures and environments, and how the provider does or intends to mitigate these risks.
• The types of support services offered and how students access these services.
• How students who require additional supports are identified and receive support.
• How flexible study policies contribute to student wellbeing.
• Approaches to address bullying, harassment, racism, and the impact of systemic bias on students.
• Crisis management strategies, including a suicide postvention policy/strategy (4.2.1, 4.2.2, 4.2.3, 4.2.5, 4.2.7).

‘Accessible’ services include accessible to students with disabilities, students with varying study and caring commitments, and students learning in locations geographically distant from university campuses. The medical education provider may offer student support services directly or through arrangements with external organisations (4.2.2).

The terms ‘reasonable adjustments’ in Australia and ‘reasonable accommodations’ in Aotearoa New Zealand have implications in each countries’ and international human rights law. Key legislation in Australia includes the Disability Discrimination Act 1992 and the Commonwealth Disability Standards for Education 2005. Key legislation in Aotearoa New Zealand includes the Human Rights Act 1993.

‘Reasonable adjustments/ accommodations’ in these standards refer to reducing barriers to ensure that people with a disability or health condition have access to medical programs and participate in the academic, occupational and social activities of their education and training. In making reasonable adjustments/ accommodations, providers ensure that the academic integrity of the medical program is maintained (4.2.3 and 4.2.4).

Providers should have processes in place to ensure that students from equity groups* and Aboriginal and/or Torres Strait Islander and Māori students who require additional supports or adjustments/ accommodations are identified and provided this support in a timely manner. For Aboriginal and/or Torres Strait Islander and Māori students, these processes and additional supports should be culturally safe and allow Aboriginal and/or Torres Strait Islander and Māori students to meet cultural and community obligations (4.2.3).

The identification of students who require additional health and learning support and reasonable adjustments/ accommodations and provision of this support should aim to be a proactive process (4.2.3). Providers should explain how this proactive identification of students and provision of supports interacts with the performance improvement program under Standard 4.2: Student wellbeing. Providers should explain the details of performance improvement programs under Standard 3.2: Assessment feedback.

The ’safe’ voluntary self-disclosure of information by medical students includes the medical program fostering a culture and setting up systems that build up student trust and confidence. Medical programs should develop and evaluate self-disclosure processes in partnership* with students and the health services/prevocational training providers* that commonly employ their graduates (4.2.4).

‘Flexible study policies*’ should address the needs of students with specific cultural and community obligations, including Aboriginal and/or Torres Strait Islander and Māori students (4.2.5).

For providers to ensure that processes for student support provision and for academic progression are ‘separated’, staff members who are responsible for student support provision should not also have responsibility for academic progression decisions (4.2.6).

Staff should be covered and protected by policies around bullying, harassment, racism and discrimination. ‘Harassment’ also includes sexual harassment (4.2.7).

Policies, reporting mechanisms and processes around bullying, harassment, racism and discrimination that ‘support the cultural safety of learning environments’ should be led by Aboriginal and/or Torres Strait Islander and Māori people and include cultural supports. Specific policies may include anti-racism policies and approaches to creating a welcoming environment.

Documentary evidence could include:

• Student wellbeing and inclusion strategy or strategies.
• The Disability Action Plan policy or similar policy regarding how provider supports individuals with disabilities.
• The number of students, including students with disabilities, receiving additional health and learning support.
• Agendas and minutes from meetings with and/or correspondence with health services related to medical student/graduate self-disclosure of information processes.
• Flexible study policies, including as relevant part-time study policy, return to study policy and/or recognition of prior learning policy.
• Descriptions/case studies of how students’ individualised needs, including to meet cultural and community obligations, are met through flexible study policies.
• Bullying, harassment, racism and discrimination policies.
• Descriptions/case studies of how bullying, harassment, racism and discrimination policies function in practice.

Interview and observational evidence could include:

• Discussions with support staff on the scope and efficacy of the wellbeing and inclusion strategy including support services.
• Discussions with students on support services and flexible study policies.
• Discussions with Aboriginal and/or Torres Strait Islander and Māori students on their access to flexible study.
• Discussions with health service staff on student support need self-disclosure mechanisms.

There are no examples at this time.

Kemp S., Hu W., Bishop J., et al. (2019) Medical student wellbeing – a consensus statement from Australia and New Zealand. BMC Med Educ. 19(69)

MDANZ: Inclusive Medical Education – Guidance on medical program applicants and students with a disability (2021)

Tweed, M. and Wilkinson, T. (2022) Making accommodations for medical students’ long-term conditions in assessments: An action research guided approach, Medical Teacher 44(5), 519-526

MDANZ: Discussion paper – Creating a Culture of Support for medical students and graduates transitioning into practice (2021)

MDANZ: Consensus Statement on Postvention Planning (2023)

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 (2017)

‘Impairment’ is defined by the Health Practitioner Regulation National Law under Section 5 as, “in relation to the person, means the person has a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect… for a student, the student’s capacity to undertake clinical training.” Many disabilities, conditions and disorders that have some detrimental effect on capacity to undertake clinical training can be accommodated through reasonable adjustments/ accommodations, and providers are expected to support the inclusion of students with disabilities where reasonable adjustments/ accommodations are possible (see Standard 4.1: Student cohorts and selection policies and Standard 4.2: Student wellbeing). Students will require management through formal processes and, where relevant, involving training sites and regulators including the Australian Health Practitioner Regulation Agency, when an impairment may impact on patient safety in terms of the student’s fitness to practice medicine and ability to interact with patients generally (4.3.1).

Providers’ policies and procedures to identify, manage and/or support students whose professional behaviour raises patient safety concerns should be sufficiently robust to protect patient safety. As part of these processes, students should be supported in the aim to address the concerns. These students should be monitored and managed through formal processes involving, where relevant, training sites and regulators including the Australian Health Practitioner Regulation Agency (4.3.2).

Staff and clinical supervisors who regularly interact with students should be aware of these policies and procedures, particularly their obligations and reporting mechanisms (4.3.1 and 4.3.2).

For both impairments and professional behaviours, considerations around patient safety always include cultural safety, including for Aboriginal and/or Torres Strait Islander and Māori people (4.3.1 and 4.3.2).

Documentary evidence could include:

• Policies and procedural documents for managing students with an impairment.
• Policies and procedural documents for identifying, managing and/or supporting students with professional behaviour concerns.
• Flow diagrams depicting these processes.
• Descriptions of mechanisms to involve training sites and regulators in patient safety concerns about student impairment and professional behaviours.
• Anonymised descriptions or reports about management of specific student impairments and professional behaviours.
• Description of processes for identifying students who may be unsuited to continue in the program and pathways for these students to exit the program.

Interview and observational evidence could include:

• Discussions with staff on the implementation of impairment policies and procedures.
• Discussions with staff on student professional behaviour policies and procedures.
• Discussions with clinical supervisors on raising concerns about impairment and/or professional behaviours with the provider.
• Discussions with students on how impairment and professional behaviour concerns are addressed.

There are no examples at this time.

There are no resources at this time.

Not applicable

Documentary evidence could include:

• Policies regarding student indemnification.
• Descriptions of insurances held by the provider.

There are no examples at this time.

There are no resources at this time.