Guidance Matrix: Standard 5

‘Educational facilities and infrastructure’ includes classrooms, staff offices and rooms, study areas, simulation facilities, labs, information communication technologies (such as internet access), and other facilities and infrastructure that explicitly facilitate learning and teaching. ‘Physical facilities’ include the general buildings, general use spaces, toilets, parking, transit hubs, and other facilities that support students and staff but are not explicitly used for learning and teaching. ‘Amenities’ are services such as accommodation, gyms and food services (5.1.1, 5.1.2 and 5.1.3)

Physical facilities that support student and staff wellbeing are appropriate for their needs and inclusive of those with specific and unique additional needs. For instance, students and staff who are parents or carers of young children require appropriate spaces for feeding and changing. Another example is that wheelchair users require accessible facilities (5.1.2).

Aboriginal and/or Torres Strait Islander and Māori students and staff should be provided with designated safe spaces to support their wellbeing where reasonable (5.1.2).

Technologies that ‘support the medical program’s teaching, learning, assessment and research’ would include, for example, Learning Management Systems, Assessment Management Systems, curriculum mapping tools and electronic portfolio systems (5.1.4).

Amenities that ‘support learning and wellbeing’, including accommodation, should be safe and reasonably affordable for students who require it. In the case of accommodation, this may require that providers make housing vouchers available or build accommodation (5.1.3).

Technology that providers use and ensure access to for delivery of their medical program should be reliable and fit for purpose (5.1.4 and 5.1.5).

‘Equitable access’ refers to an understanding that not all clinical placement sites will provide students with access to all technologies used in the curriculum, but that students should have access to core curriculum, teaching, learning and assessment delivery technologies such as the Learning Management System, online information services and any other technology required to achieve medical program outcomes (5.1.5).

Documentary evidence could include:

• Descriptions of educational facilities and infrastructure available to the medical program, including access arrangements.
• Descriptions of physical facilities available to the medical program, including how these contribute to student and staff wellbeing.
• Descriptions of amenities available to students on placements, including how these support student learning and wellbeing.
• Descriptions of major capital works or other initiatives that expand, reduce or otherwise affect access to educational facilities and infrastructure, physical facilities and amenities.
• Student survey questionnaires and analysis of feedback related to educational facilities and infrastructure, physical facilities and amenities, including whether responses differ at varying program sites.
• Placement site accommodation provision policy.
• Descriptions of clinical and educational technologies available at different clinical placement sites.
• Documentation around technical capabilities of technologies used to support teaching, learning, assessment and research, such as the Learning Management System, including policies/guides on their use.
• Descriptions of how a Learning Management System and/or curriculum mapping tool is used to support learning and teaching delivery.
• Descriptions of how an Assessment Management System and/or electronic portfolio is used to support assessment teams and outcomes.
• Descriptions of library, reference resources, and support staff available to students, and how access is distributed across program sites.
• Review of policies that outline the process and the frequency of reviews of facilities, amenities, and technologies to ensure continued alignment to medical program outcomes and purpose.

Interview and observational evidence could include:

• Discussions with students on the nature of educational facilities and infrastructure, physical facilities, amenities, and access to various technologies; including how this may differ across program sites.
• Discussions with Aboriginal and/or Torres Strait Islander and Māori students and staff on the provision of safe spaces.
• Discussions with academic and professional staff on the program’s needs and uses of technology in the delivery of the medical program.
• Observation of campuses and key clinical placement sites.
• Observation of the educational facilities and infrastructure, physical facilities and amenities.
• Observation of library and reference resources.

There are no examples at this time.

There are no resources at this time.

‘Sufficient’ academic staff refers to the numbers of employed staff, reasonable turnover and vacancy rates for key staff roles, and that employed staff are appropriately skilled and have relevant expertise to cover the range of educational needs of the program, learning and teaching methods and workload and assessment required for all students to achieve the AMC graduate outcome statements (5.2.1).

An ‘appropriate profile’ of professional staff refers to the numbers of staff and their roles, particularly in addressing curriculum priorities. Key areas include administration, information technology, laboratory support, student wellbeing, and managing engagement with clinical partners and communities. (5.2.2).

Strategies for recruiting and retaining Aboriginal and/or Torres Strait Islander and Māori staff may include:

• “Grow your own” processes for creating interest in and opportunities for Aboriginal and/or Torres Strait Islander and Māori students, junior staff and leaders.
• Identification of risks, such as cultural safety concerns, cultural loading and key person risks (5.2.3).

‘Educational expertise’ can be garnered through a range of qualifications and expertise. The contribution of this expertise should generally be formalised through identified educational and teaching roles, and access to continuing professional development (5.2.4). Details of professional development opportunities available to staff should be reported under Standard 5.3: Staff appointment, promotion and development.

Learning and teaching activities should be informed by and, when relevant, directly engage patients and community members to meet these standards and ensure graduates achieve the AMC graduate outcome statements. Providers should understand barriers to participation and work to mitigate these where possible. Patients and community members from community groups who experience health inequities and Aboriginal and/or Torres Strait Islander and Māori communities should be involved in learning and teaching activities:

• In a culturally safe manner.
• Respecting and acknowledging their lived experience.

Only when fully informed of the scope and purpose of activities, and only engaged when they have the relevant knowledge and the resilience to share it (5.2.5).

Documentary evidence could include:

• The human resources strategy.
• The number of funded academic positions associated with the medical program, currently filled or vacant, expressed in full-time equivalent and numbers of staff.
• Details of annual medical program staff turnover and vacancy rates.
• For vacant positions, a description of which roles are essential to the delivery of the medical program, how the key responsibilities are covered while the role is vacant, and recruitment processes in place.
• Descriptions of how the provider tracks the sufficiency of academic staff and the profile of professional staff.
• If the numbers of academic and/or professional staff are or are intended to be reduced, an impact analysis of the reduction on student and staff experience, which includes stakeholder views, and the ability of the provider to achieve its purpose and implement and develop the program.
• Organisational charts/flow charts outlining the overall structure and reporting lines of academic and professional staffing and teams.
• Descriptions of the general role and duty allocations of clinical titleholders and conjoint appointments.
• The recruitment and retention strategy for Aboriginal and/or Torres Strait Islander and Māori staff and implementation progress reports, which may be part of the overall human resources strategy.
• Numbers and roles of Aboriginal and/or Torres Strait Islander and Māori staff.
• Numbers and roles of staff requiring expertise in medical education as a component of the position description.
• Descriptions of recruitment, support and training arrangements for patients and community members engaged in learning and teaching activities, including measures taken to ensure the engagement of community groups who experience health inequities and Aboriginal and/or Torres Strait Islander and Māori communities.
• Documentation related to staff indemnification.

Interview and observational evidence could include:

• Discussions with academic and professional staff on the resourcing approach to staff recruitment and retention.
• Discussions with Aboriginal and/or Torres Strait Islander and Māori staff on their recruitment and retention.
• Discussions with community stakeholders on their involvement in learning and teaching activities.

There are no examples at this time.

Huria, T., Lacey, C., Pitama, S. (2013) Friends with benefits: should Indigenous medical educators involve the Indigenous community in Indigenous medical education? In, LIME Network: LIME Good Practice Case Studies, Vol 2. FMDHS UoM, Melbourne 35-38.

A ‘balance of capacity’ for teaching, research and service should be fostered by providers through balanced role descriptions and teaching loads in practice (5.3.1).

Appointment and promotion policies that ‘include a culturally safe system for measuring success of Aboriginal and/or Torres Strait Islander and Māori staff’ acknowledge:

• Growing demands on these staff, including additional cultural expectations and cultural loading.
• The impacts of colonisation, racism and bias on Aboriginal and/or Torres Strait Islander and Māori staff (5.3.1).

‘Appropriate’ professional development opportunities and support for Aboriginal and/or Torres Strait Islander and Māori staff are best defined by these staff, as supported by good practice and case studies. The facilitation of work in teams and mentoring for Aboriginal and/or Torres Strait Islander and Māori staff usually relies on the provider having (an) Aboriginal and/or Torres Strait Islander and Māori education unit(s) (5.3.3).

Training in cultural safety should be:

• Led, designed and assessed by Aboriginal and/or Torres Strait Islander and Māori experts (following also from standards 2.3.7 and 3.1.6).
• Relevant to the context of the program.

Where possible, accredited by a recognised training accreditation authority (5.3.4).

Documentary evidence could include:

• Appointment and promotion policies, including recognition and reward for teaching, research, curriculum development and service contributions.
• Performance appraisal policies.
• Descriptions of the renewal and appointment processes for academic staff, including clinical title holders and conjoint appointments.
• Descriptions of professional development opportunities available to academic staff and the level of participation in these opportunities in practice.
• Descriptions of training and professional development opportunities for professional staff to support skills development needed for supporting the medical program.
• Descriptions of professional development opportunities and support for Aboriginal and/or Torres Strait Islander and Māori staff. This includes both specific opportunities and how general opportunities are tailored to be more appropriate.
• Descriptions of initiatives and outcomes from teamwork and mentorship opportunities, particularly for Aboriginal and/or Torres Strait Islander and Māori staff.
• Descriptions of how clinical title holders and conjoint appointments are involved in the program and appraised and developed by the provider.
• Documentation relating to cultural safety training, including the system used to track staff, clinical supervisor and student participation in this training.

Interview and observational evidence could include:

• Discussions with academic staff on the appointment and promotion processes and the efficacy and accessibility of development opportunities.
• Discussions with professional staff on appraisal processes and the efficacy and accessibility of development opportunities.
• Discussions with clinical title holders and conjoint appointment role holders on appointment and promotion, professional development and opportunities through the provider.
• Discussions with Aboriginal and/or Torres Strait Islander and Māori staff on appointment and promotion, professional development, support and opportunities for teamwork and mentorship.

There are no examples at this time.

LIME Network: Best Practice Approaches to Supporting Indigenous Health Academics in Medical Schools (2020)

The provider should demonstrate the quality and efficacy of their relationships with health services and other partners, and relate this to the quality of students’ clinical experiences (5.4.1). Providers should explain under Standard 5.4, Clinical learning environment, how their relationships enable high-quality clinical experiences. Providers should explain the details of those relationships, particularly how they are formalised, under Standard 1.2: Partnerships with communities and engagement with stakeholders. Providers should explain student opportunities to learn with and learn from diverse patient groups; and learn in diverse healthcare settings, under Standard 2.3: Learning and teaching.

In ensuring ‘adequate and culturally safe opportunities for all students to have clinical experience in providing health care to Aboriginal and/or Torres Strait Islander and Māori people’, providers should recognise that Aboriginal and/or Torres Strait Islander and Māori people seek and are provided care in all healthcare settings, not only in community controlled health settings. While community controlled health settings will have the most concentrated opportunities for students to gain this clinical experience, the AMC recognises that these settings have limited capacity and resources to both facilitate student learning and provide appropriate care to their patients. Providers should implement structured and culturally safe opportunities in Aboriginal and/or Torres Strait Islander and Māori health across their clinical sites, including tertiary and community settings. Where providers partner with community controlled health settings to place students in those settings, providers should ensure there is benefit for those health settings such that their overall resources are not diminished (5.4.2; see Standard 1.2: Partnerships with communities and engagement with stakeholders).

The AMC does not specify minimum contact hours or types of experiences that form ‘adequate’ clinical experiences in Aboriginal and/or Torres Strait Islander and Māori health. Students should be able to meet all AMC Graduate Outcome Statements related to Aboriginal and/or Torres Strait Islander and Māori health and cultural safety, and their clinical experiences should reinforce cultural safety training (see standard 5.3.4) and other cultural learning as part of the Aboriginal and/or Torres Strait Islander and Māori health curriculum (see standards 2.2.2 and 2.2.3).

Documentary evidence could include:

• Descriptions of how the clinical learning environments enable students to achieve the medical program outcomes through high-quality clinical experiences.
• Descriptions of how relationships with health services and other partners ensure high-quality clinical experiences.
• Agendas and minutes from meetings with health services and other partners on clinical experience quality.
• Descriptions of how teaching opportunities and service responsibilities are balanced, both for clinical supervisors and for the learning environments themselves.
• Descriptions of the opportunities for students to have clinical experience in providing health care to Aboriginal and/or Torres Strait Islander and Māori people.
• Descriptions of how these opportunities are mapping to learning outcomes and the Aboriginal and/or Torres Strait Islander and Māori health curriculum.
• Agendas and minutes from meetings with co-located health profession education providers on clinical facilities and teaching capacity.

Interview and observational evidence could include:

• Discussions with health services and other (clinical placement) partners on how their relationship with the provider supports high-quality clinical experiences.
• Discussions with academic, clinical and professional staff responsible for clinical placements on the relationships that support clinical experiences.
• Discussions with students about their learning across the range of diverse learning environments encountered including the adequacy of their opportunities to have clinical experience in Aboriginal and/or Torres Strait Islander and Māori health.
• Discussions with students on the quality of their clinical experiences.
• Discussions with community controlled organisations on the scope of clinical learning opportunities for students.
• Discussions with co-located health profession education providers, including medical programs, on engagement with the provider on clinical facilities and teaching capacity.

There are no examples at this time.

There are no resources at this time.

An ‘effective system of clinical supervision’ refers to a system where the supervision arrangements are clear, explicit and accountable. Supervisors* guide the students’ clinical experience and clinical training. Supervisors should have the appropriate competencies, skills, knowledge and commitment to the program. This includes knowledge of the program requirements, understanding of the principles of learning, the ability to provide constructive and actionable feedback to students, and responding appropriately to identified concerns. Supervisors must behave professionally and appropriately, including in a culturally safe manner. The system should be sufficiently organised and centred around education to allow students to continuously learn and progressively achieve learning outcomes (5.5.1).

Providers should explain under Standard 5.5: Clinical supervision, the overall system of clinical supervision and the specific details of each clinical site, such as clinical supervisor to student ratios, requirements around student feedback time, and after-hours availability. Providers should explain how students are develop and practice procedural skills before applying them in a clinical setting, and have increased involvement in patient care as their skills develop, under Standard 2.3: Learning and teaching.

The paramount concern referred to with ‘safe involvement’ of students in clinical practice is patient safety. The safety of students must also be ensured. Safety, for both patients and students, implies physical, psychological, emotional and cultural safety, as particularly but not exclusively described in quality and safety frameworks, legislation and clinical guidelines; as well as occupational health and safety principles and legislation. Patient safety will be protected through an effective system of supervision (5.5.1).

Training for clinical supervisors may be offered in partnership with a health service and may include topics such as clinical assessment, giving feedback, assessment quality, fostering cultural safety learning environments, and obligations and duties of supervisors including professionalism. Clinical supervisors having ‘access to’ training includes that this training is readily accessible and that supervisors are aware of the availability of this training. While not a formal requirement in the standards, AMC strongly encourages providers to ensure that clinical supervisors undertake training in the areas of supervision, assessment and the use of health education technologies (5.5.2).

Orientation for clinical supervisors should cover provider policies around supervision and raising concerns, provider expectations of supervisors, provider responsibilities towards supervisors, monitoring and performance recognition processes, and training and professional development opportunities (5.5.2).

‘Monitor[ing] the performance’ of clinical supervisors means collecting individual and collective data, such as student and peer feedback, that allows a provider to monitor professionalism including cultural safety of supervisors and make informed determinations on professional development and training needs, as well as allowing for recognition of performance. This performance monitoring does not need to fall within the formal provider performance appraisal system for staff (this formal system for the provider’s staff is required under standard 5.3.2). The provider should work in close partnership* with clinical sites to monitor the performance of supervisors (5.5.3).

Documentary evidence could include:

• Descriptions of the overall system of clinical supervision and how the specific features of this system differ across sites.
• Policies around supervisory requirements, including minimum supervisor to student ratios, student scope of practice and what students are able to do without close supervision to provide different types of care in the different phases of the program, and after-hours supervision.
• Ratios of supervisors to students in different sites, broken down by supervisor profession and seniority.
• Descriptions of how patient safety and student safety is ensured through the system of clinical supervision.
• Descriptions of content and delivery of orientation for supervisors.
• Syllabi for supervisor training courses in supervision, workplace based assessment and the use of relevant health education technologies.
• Numbers of supervisors who undertake the various training courses made available by the provider, against the total number of supervisors.
• Descriptions of supervisor monitoring and performance recognition processes.
• Sample data collected as part of the supervisor monitoring process.
• Descriptions of how the provider works with healthcare facilities to ensure that facility staff have sufficient time for teaching within clinical service requirements to maintain an effective system of clinical supervision.
• Correspondence with and agendas and minutes from meetings with healthcare facilities on facility staff time for teaching and supervision within clinical service requirements.
• Policies and written agreements, such as agreements between the provider and health facilities and contracts between the provider and individual supervisors, that outline the responsibilities of practitioners who contribute to the program and the responsibilities of the provider towards those practitioners. These responsibilities may include minimum time requirements and adherence to provider policies; and access to professional development and rights that academic status confers, respectively.

Interview and observational evidence could include:

• Discussions with staff who coordinate clinical supervision on how the system of clinical supervision ensures safe involvement of students in clinical practice.
• Discussions with clinical supervisors on their responsibilities vis-à-vis the provider, including provision of orientation and access to training.
• Discussions with health care facilities on providers’ engagement with them on the system of clinical supervision, including around time allocation within clinical service requirements.
• Discussions with students on the system of clinical supervision.

There are no examples at this time.

There are no resources at this time.