Inherent requirements for studying medicine in Australia and New Zealand

Endorsed by the Inherent Requirement Working Group 21st September 2015

Endorsed by the Executive Committee of Medical Deans Australia and New Zealand 29th September
2015

Endorsed by Members Representative of Medical Deans Australia and New Zealand 8 th October 2015
at the Medical Deans Annual Conference
 Use of this document

This document is a guideline statement that has been accepted by all medical
schools in Australia and New Zealand. All University medical schools will be
provided with a copy of these guidelines and they will be implemented locally as
required by individual medical schools.

Students enrolling in a medical course at these medical schools may be required to

read the document and acknowledge that they understand the content. Any issues
highlighted in this document must be brought to the attention of the relevant medical
school. They may be required to reconfirm their status periodically during the course.

This document will be also be distributed to key stakeholders as part of an initial 12

month consultation and implementation phase. Feedback on this phase will be
provided by members and stakeholders with a planned discussion at the Medical
Deans Annual Conference in 2016

This document and its implementation will be formally reviewed in 2 years

NB This document specifically does not provide guidance on inherent requirements

related to infectious diseases.

This guideline statement has been prepared by:

Professor Ian Wilson (Chair) and members of the Inherent Requirement Working Group,
Medical Deans Australia and New Zealand Inc
[email protected]
02 8084 6557

In preparation of this statement we wish to acknowledge the significant support from all
members of the working groups past and present
Background

The inherent requirements for medical students have been developed by the Medical
Deans Australia and New Zealand (Medical Deans) and originated from those
developed by the University of Western Sydney.1 Other information has been
incorporated, most notably the Higher Education Occupational Physicians (HEOPS) /
Practitioners: Medical students – standards of medical fitness to train.2

In 2010 a review of the Australian Disability Standards for Education 20053

recommended the standards

“… require tertiary institutions to publish detailed inherent requirements of

every course they offer. This will allow students with a disability to select
courses confident that they understand, and can reasonably expect to meet,
the inherent requirements of that course.”4

These Inherent Requirements are to be used in professional entry level medical

training with the aim of providing the greatest access for students with a disability
while ensuring quality patient care. These Requirements should not be seen as
applying after graduation when reference should be made to the standards outlined
in Good Medical Practice: A Code of Conduct5. Specifically, these requirements are
not intended to indicate that a graduate doctor who has satisfied the inherent
requirements would necessarily be able to find job in the medical field of their choice.
That is, some graduates with disabilities may still find some areas of medical practice
unsuitable.

Definition

An Inherent Requirement is defined as: “the fundamental components of a course or

unit, that are essential to demonstrate the capabilities, knowledge and skills to
achieve the core learning outcomes of the course or unit, while preserving the

1 http://www.uws.edu.au/ir/inherent_requirements/inherent_requirements_for_medicine_courses
*Developed from: Johnson, A., Allan,T., Phillips,K., Azzopardi,T., Dickson,C., Goldsmith,M & Hengstberger-Sims,
C. (2011). Inherent Requirements of Nursing Education (IRONE), UWS School of Nursing & Midwifery and
Student Equity & Disability Services.
2 http://www.heops.org.uk/HEOPS_Medical_Students_fitness_standards_2013_v10.pdf
3

http://docs.education.gov.au/system/files/doc/other/disability_standards_for_education_2005_plus_gu
idance_notes.pdf and
http://docs.education.gov.au/system/files/doc/other/disability_standards_for_education_2005_guidanc
e_notes.pdf
4

http://docs.education.gov.au/system/files/doc/other/report_on_the_review_of_disability_standards_for
_education_2005.pdf
5 http://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx
academic integrity of the university’s learning, assessment and accreditation
processes. Note: making a requirement compulsory does not necessarily make it an
inherent requirement.”6

The concept of reasonable accommodation or adjustment covers campus design,

including the provision of equipment and access, and study course design. Applying
the concept means that academic and administrative staff, wherever it is necessary,
possible and reasonable to do so, take into account a student’s disability and make
appropriate adjustments to the learning environment to lessen the impact of the
disability.7

Medical training takes place in a number of off-campus venues including hospitals

and community practices where the medical school may not be able to make
reasonable adjustments. The choice of training venue may be the best adjustment
that a medical school can provide. In general however, the venues for training are
the same or similar as the venues for future practice. This means that having a
disability that prevents training in a particular context may have implications for
practising in that context.

The AVCC has stated (1996), “universities should have in place teaching and
assessment strategies which are appropriate to students with disabilities. The
assessment policies and practices of the university should make explicit provision for
the use of procedural variations and/or alternative assessment strategies for
students with disabilities”.8

Where an adjustment is unreasonable a university does not need to make the

change. An adjustment can be considered unreasonable where
1. It impacts negatively on the student him/herself
2. It impacts negatively on staff or other students
3. It impacts negatively on academic standards
4. It puts others, including staff, students or patients at risk9

6 UWS Inherent Requirements Working Party, 2010

7 Reasonable Accommodations: Strategies for teaching university students with disabilities, 1993. p.3.
Macquarie University
8 Australian Vice-Chancellors’ Committee (AV-CC). (1996). Guidelines relating to students with

disabilities. Canberra, Paragon Printers, s.4.4. p.3

9 Based on information in

http://docs.education.gov.au/system/files/doc/other/disability_standards_for_education_2005_plus_gu
idance_notes.pdf
The following inherent requirements are categorised under the headings of the
course learning outcomes for medical programs produced by the Australian Medical
Council.
 DOMAIN 1
SCIENCE AND SCHOLARSHIP: THE MEDICAL GRADUATE AS SCIENTIST AND
SCHOLAR

On entry to professional practice, Australian and New Zealand graduates are able to:

1.1 Demonstrate an understanding of established and evolving biological, clinical,

epidemiological, social, and behavioural sciences.

1.2 Apply core medical and scientific knowledge to individual patients, populations and health
systems.

1.3 Describe the aetiology, pathology, clinical features, natural history and prognosis of common
and important presentations at all stages of life.

1.4 Access, critically appraise, interpret and apply evidence from the medical and scientific
literature.

1.5 Apply knowledge of common scientific methods to formulate relevant research questions and
select applicable study designs.

1.6 Demonstrate a commitment to excellence, evidence based practice and the generation of
new scientific knowledge.
Knowledge and cognitive skills

Consistent and effective knowledge and cognitive skills must be demonstrated to

provide safe and competent medical care. Medical students must be able to process
knowledge and cognition in a rapid and timely manner appropriate to the clinical
context.

A medical student is expected to demonstrate the:

1. Capacity to locate appropriate and relevant information
2. Ability to process information relevant to practice
3. Ability to integrate and implement knowledge in practice

At entry a medical student’s knowledge and cognition will be assessed by a variety

of means including, for example, ATAR, GPA, UMAT and GAMSAT amongst other
assessments.10

During the medical course a medical student’s knowledge and cognition will be
assessed by performance in assessments and during small group and clinical
teaching.

Literacy

Competent literacy skills are essential to provide safe and effective delivery of
medical care.

A medical student is expected to demonstrate the:

1. Ability to accurately acquire information and convey appropriate, effective
messages
2. Ability to read and comprehend a range of literature and information
3. Capacity to understand and implement academic conventions and to
construct written text in a scholarly manner

At entry a medical student’s literacy will be assessed by a variety of means including,

for example, ATAR, GPA, UMAT and GAMSAT and performance in selection
interviews.

During the medical course a medical student’s literacy will be assessed by

performance in assessments and during small group and clinical teaching.

10Australian Tertiary Admission Ranking, Grade Point Average, Undergraduate Medical and Health
Sciences Admission Test, Graduate Australian Medical School Admission Test
Numeracy

Competent and accurate numeracy skills are essential for safe and effective patient
care.

A medical student is expected to

1. Interpret and correctly apply data, measurements and numerical criteria.
2. Prescribe safely and effectively including calculating drug dosages

At entry a medical student’s numeracy will be assessed by a variety of means

including, for example, ATAR, GPA, UMAT and GAMSAT.

During the course a medical student’s numeracy will be assessed by performance in

assessments and during small group and clinical teaching.
 DOMAIN 2
CLINICAL PRACTICE: THE MEDICAL GRADUATE AS PRACTITIONER

On entry to professional practice, Australian and New Zealand graduates are able to:

2.1 Demonstrate by listening, sharing and responding, the ability to communicate clearly,
sensitively and effectively with patients, their family/carers, doctors and other health
professionals.

2.2 Elicit an accurate, organised and problem-focussed medical history, including family and
social occupational and lifestyle features, from the patient, and other sources.

2.3 Perform a full and accurate physical examination, including a mental state examination, or a
problem-focused examination as indicated.

2.4 Integrate and interpret findings from the history and examination, to arrive at an initial
assessment including a relevant differential diagnosis. Discriminate between possible
differential diagnoses, justify the decisions taken and describe the processes for evaluating
these.

2.5 Select and justify common investigations, with regard to the pathological basis of disease,
utility, safety and cost effectiveness, and interpret their results.

2.6 Select and perform safely a range of common procedural skills.

2.7 Make clinical judgements and decisions based on the available evidence. Identify and justify
relevant management options alone or in conjunction with colleagues, according to level of
training and experience.

2.8 Elicit patients’ questions and their views, concerns and preferences, promote rapport, and
ensure patients’ full understanding of their problem(s). Involve patients in decisionmaking and
planning their treatment, including communicating risk and benefits of management options.

2.9 Provide information to patients, and family/carers where relevant, to enable them to make a
fully informed choice among various diagnostic, therapeutic and management options.

2.10 Integrate prevention, early detection, health maintenance and chronic condition
management where relevant into clinical practice.

2.11 Prescribe medications safely, effectively and economically using objective evidence. Safely
administer other therapeutic agents including fluid, electrolytes, blood products and selected
inhalational agents.

2.12 Recognise and assess deteriorating and critically unwell patients who require immediate
care. Perform common emergency and life support procedures, including caring for the
unconscious patient and performing CPR.

2.13 Describe the principles of care for patients at the end of their lives, avoiding unnecessary
investigations or treatment, and ensuring physical comfort including pain relief, psychosocial
support and other components of palliative care.
2.14 Place the needs and safety of patients at the centre of the care process. Demonstrate safety
skills including infection control, graded assertiveness, adverse event reporting and effective
clinical handover.

2.15 Retrieve, interpret and record information effectively in clinical data systems (both paper and
electronic).
Verbal Communication

Effective and efficient verbal communication, in English, is an essential requirement

to provide safe delivery of care during medical training.

A medical student is expected to demonstrate:

1. The ability to understand and respond to verbal communication accurately,
appropriately and in a timely manner
2. The ability to provide clear and timely instructions in the context of the
situation
3. Speak English clearly

Note: IELTS 7.0 (or other standard as promulgated) is required by AHPRA for
international students at the point of commencing internship. One promulgated
criterion (HEOPS) is the ability to be understood at 3 m in a quiet room

At entry verbal communication can be assessed during selection interviews (if

used) or by other measures.

During the course a student’s verbal communication will be assessed during

assessments and teaching episodes.

Non-verbal Communication

Effective non-verbal communication is fundamental to medicine and needs to be

respectful, clear, attentive, empathetic, honest and non-judgemental.

A medical student is expected to demonstrate:

1. The capacity to recognise, interpret and respond appropriately to non-verbal
cues
2. Consistent and appropriate awareness of own non-verbal behaviours

At entry non-verbal communication can be assessed during selection interviews

(if used) or by other measures

During the course a student’s non-verbal communication will be assessed during

assessments and teaching episodes.
Written Communication

Effective written communication is a fundamental medical responsibility with

professional and legal ramifications.

A medical student is expected to

1. Demonstrate capacity to construct coherent written communication
appropriate to the circumstances.
2. Record and communicate their thoughts in a timely manner
3. Complete medical records, reports and letters in a timely manner

At entry written communication can be assessed as part of the selection

processes

During the course a student’s written communication will be assessed during

written examinations and during teaching episodes

Vision

Adequate visual acuity is required to provide safe and effective medical care.

A medical student is expected to demonstrate

Sufficient visual acuity to perform the required range of skills, including
a. Reading small print on ampoules or similar
b. Reading a monitor across a bed
c. Responding to visual alarms

Note: One set of promulgated criteria (HEOPS) state that a visual acuity with
maximal correction of N8 and/ or 6/18 (or better) is required for the practice of
medicine.

Students whose vision is insufficient to meet these criteria or who have significant
other visual problems (such as visual field defects, nystagmus, etc) may require
assessment by an ophthalmologist.

At entry a medical student’s visual difficulties will be documented through self-

declaration.

During the course a medical student’s visual difficulties will become apparent during
assessments and clinical training.
Hearing

Adequate auditory ability is required to provide effective and safe medical care.

A medical student is expected to demonstrate:

1. Sufficient aural function to undertake the required range of tasks.
2. The ability to work effectively in the emergency situation

Note: One set of promulgated criteria (HEOPS) state the following.

A student, wearing functioning hearing aids (if required), should demonstrate
1. The ability to understand the human voice at 1 m.
2. Less than 40 db loss across speech frequencies.

At entry a medical student’s hearing difficulties will be documented through self-

declaration or during the selection interview.

During the course a medical student’s hearing difficulties will become apparent
during assessments, small group teaching and clinical training.

Touch

Sufficient tactile ability is required to perform competent and safe medical care.

A medical student is expected to demonstrate:

1. Sufficient fine touch to undertake the required range of skills and clinical
assessments, such as palpation of vessels and organs, and to estimate the size
of skin lesions

At entry a medical student’s difficulties with touch will be documented through self-
declaration.

During the course a medical student’s difficulties with touch will become apparent
during assessments and clinical training.
Mobility and gross motor skills

Mobility and gross motor skills are required in medicine to undertake appropriate
clinical care.

A medical student is expected to demonstrate:

1. The ability to perform gross motor skills to undertake a full physical
examination, cardiopulmonary resuscitation and to function within scope of
practice
2. Independent mobility in order to attend medical emergencies when required

One set of promulgated criteria (HEOPS) indicate a student must

1. Demonstrate the ability to undertake a full physical examination avoiding
injury to patients, colleagues and self
2. Possess one fully functional arm and the other capable of providing support

At entry a medical student’s impaired mobility will be apparent through self-

declaration or during the selection interview.

During the course a medical student’s impaired mobility will become apparent during
clinical skills training and clinical practice

Fine motor skills

Medicine is a profession that requires manual dexterity, and possession of fine motor
skills is fundamental in providing adequate clinical care.

A medical student is expected to demonstrate:

1. The ability to use fine motor skills to provide safe effective diagnosis,
treatment and clinical care.
2. The ability to undertake a full physical examination without harming patient or
self.
3. One fully functional arm and the other capable of providing support.

Medical students, by the end of their training should be able to carry out the
following; Venepuncture, wound suture, intravenous cannulation and other practical
procedures as determined by the School

At entry a medical student with impaired fine motor skills will be documented through
self-declaration or during the selection interview.
During the course a medical student with impaired fine motor skills will become
apparent during assessments, clinical skills training and clinical practice
Sustainable performance

Medical practice requires both physical and mental performance at a consistent and
sustained level to meet individual student needs over time. Medical courses are
typically integrated over the course of a year and are structured to ensure
progressive development of attributes. Fragmentation of the course, for example
through prolonged absences during parts of the year or during parts of a day,
hinders such learning. A medical student can expect to attend for 35 – 40 hours per
week for over 40 weeks a year. A medical student will be required to undertake the
course in a fulltime, continuous fashion.

A medical student is expected to demonstrate:

1. Consistent and sustained level of physical energy to complete a specific task
in a timely manner and over time
2. The ability to perform repetitive activities with a level of concentration that
ensures a capacity to focus on the activity until it is completed appropriately
3. The capacity to maintain consistency and quality of performance throughout
the designated period of duty
4. The ability to undertake the course as a fulltime student

At entry a medical student’s inability to sustain performance will be documented

through self-declaration.

During the course a medical student’s difficulties with sustainable performance will
become apparent during the course.

Interruptions to consciousness

Medical practice requires the student to be conscious and aware at all times when
interacting with patients. Unexpected interruptions to consciousness place patients
at risk.

A medical student is expected to demonstrate:

That there must be no risk of interruptions of consciousness that would
present a risk to patients

Poorly or uncontrolled epilepsy in a medical student will put patients at significant

risk. Narcolepsy and repetitive fainting will require careful assessment and treatment.
At entry a medical student’s experience of interruptions to consciousness will be
documented through self-declaration.

During the course a medical student’s difficulties with interruptions to consciousness

will become apparent during the course.
 DOMAIN 3
HEALTH AND SOCIETY: THE MEDICAL GRADUATE AS A HEALTH ADVOCATE

On entry to professional practice, Australian and New Zealand graduates are able to:

3.1 Accept responsibility to protect and advance the health and wellbeing of individuals,
communities and populations.

3.2 Explain factors that contribute to the health, illness, disease and success of treatment of
populations, including issues relating to health inequities and inequalities, diversity of cultural,
spiritual and community values, and socio-economic and physical environment factors.

3.3 Communicate effectively in wider roles including health advocacy, teaching, assessing and
appraising.

3.4 Understand and describe the factors that contribute to the health and wellbeing of Aboriginal
and Torres Strait Islander peoples and/or Māori, including history, spirituality and relationship
to land, diversity of cultures and communities, epidemiology, social and political determinants
of health and health experiences. Demonstrate effective and culturally competent
communication and care for Aboriginal and Torres Strait Islander peoples and/or Māori.

3.5 Explain and evaluate common population health screening and prevention approaches,
including the use of technology for surveillance and monitoring of the health status of
populations. Explain environmental and lifestyle health risks and advocate for healthy lifestyle
choices.

3.6 Describe a systems approach to improving the quality and safety of health care.

3.7 Understand and describe the roles and relationships between health agencies and services,
and explain the principles of efficient and equitable allocation of finite resources, to meet
individual, community and national health needs.

3.8 Describe the attributes of the national systems of health care including those that pertain to
the health care of Aboriginal and Torres Strait Islander peoples and/or Maori.

3.9 Demonstrate an understanding of global health issues and determinants of health and
disease including their relevance to health care delivery in Australia and New Zealand and the
broader Western Pacific region.

See statements relating to Verbal Communication and Written Communication on

pages 11 and 12
 DOMAIN 4
PROFESSIONALISM AND LEADERSHIP: THE MEDICAL GRADUATE AS A
PROFESSIONAL AND LEADER11

On entry to professional practice, Australian and New Zealand graduates are able to:

4.1 Provide care to all patients according to “Good Medical Practice: A Code of Conduct for
Doctors in Australia” and “Good Medical Practice: A Guide for Doctors” in New Zealand.

4.2 Demonstrate professional values including commitment to high quality clinical standards,
compassion, empathy and respect for all patients. Demonstrate the qualities of integrity,
honesty, leadership and partnership to patients, the profession and society.

4.3 Describe the principles and practice of professionalism and leadership in health care.

4.4 Explain the main principles of ethical practice and apply these to learning scenarios in clinical
practice. Communicate effectively about ethical issues with patients, family and other health
care professionals.

4.5 Demonstrate awareness of factors that affect doctors’ health and wellbeing, including fatigue,
stress management and infection control, to mitigate health risks of professional practice.
Recognise their own health needs, when to consult and follow advice of a health professional
and identify risks posed to patients by their own health.

4.6 Identify the boundaries that define professional and therapeutic relationships and
demonstrate respect for these in clinical practice.

4.7 Demonstrate awareness of and explain the options available when personal values or beliefs
may influence patient care, including the obligation to refer to another practitioner.

4.8 Describe and respect the roles and expertise of other health care professionals, and
demonstrate ability to learn and work effectively as a member of an inter-professional team or
other professional group.

4.9 Self-evaluate their own professional practice; demonstrate lifelong learning behaviours and
fundamental skills in educating colleagues. Recognise the limits of their own expertise and
involve other professionals as needed to contribute to patient care.

4.10 Describe and apply the fundamental legal responsibilities of health professionals
especially those relating to ability to complete relevant certificates and documents, informed
consent, duty of care to patients and colleagues, privacy, confidentiality, mandatory reporting
and notification. Demonstrate awareness of financial and other conflicts of interest.

11 At the time of publication the Inherent Requirement Working Group acknowledges the parallel work
being undertaken in this domain by the AMC Professionalism Working Group. Recommendations by
this group may lead to future modifications of the guidelines contained in Domain 4 of this document
Ethical behaviour

Medical students are part of a profession governed by codes, guidelines and policies
where students (and practitioners) are both accountable and responsible for
ensuring professional behaviour in all contexts.

A medical student is expected to

1. Adhere to the applicable Codes, Guidelines and Policies of the Medical Board
of Australia, the Medical Council of New Zealand and other relevant statutory
authorities at all times
2. Behave ethically at all times including times of significant stress
3. Satisfactorily complete the required Criminal Record Check and self-declaration

At entry all medical students will be required to complete a Criminal Record Check
and (if required) a self-declaration of previous ethical and/or dishonest behaviour.
The self-declaration is to be in line with that completed by each registered
practitioner at the time of re-registration. If there are previous misdemeanours, the
onus will be on the student to convince the School that such misdemeanours no
longer pose a substantial risk.

During the course medical students are required to

Complete a Criminal Record Check (CRC) as required – currently every three years
(NZ)
Complete a self-declaration at the commencement of each academic year.

Monitor and manage own health

Behavioural stability is the ability of a medical student to monitor and manage their
own mental and physical health.

Behavioural stability is required to function and adapt effectively and sensitively in a

demanding role.

A medical student is expected to

1. Demonstrate sufficient behavioural stability in order to work constructively in a
diverse and changing academic and clinical environment
2. Display the resilience and flexibility to satisfactorily deal with the demands of
being a medical student
3. Monitor their own health and behaviour and to seek help when required
At entry all medical students can demonstrate their ability to meet this requirement
by self-declaration.

During the course medical students will demonstrate their compliance with this
requirement through annual self-declaration and by assessment of their behaviour.

Legal

Medical practice is mandated by specific legislation to enable the safe delivery of

care.

A medical student is expected to comply with Australian or New Zealand Law,

professional regulations and scope of practice.

At entry all medical students must complete a Criminal Record Check.

During the course medical students can demonstrate compliance with annual self-
declaration at the time of entry into the clinical setting.

Note – in New Zealand a new Criminal Record Check is required every three years