Transcript Examining Students’ Experiences of Indigenous Health

Examining Students’ Experiences
of Indigenous Health within the
Monash MBBS
Lana Prout
MBBS (Hons)
BMedSc (Hons)
Introduction
Indigenous people, encompassing
those of both Aboriginal and Torres
Strait Islander origin, remain the least
healthy group of people in Australia,
with an average life expectancy 17
years lower than the national average
(ABS, 2007). The reasons for this are
complex and numerous.
The achievement of substantial
improvements in Indigenous health will
depend on both health and nonhealth sectors working together with
Indigenous leaders and communities.
Introduction
The education of future medical
practitioners must take into
consideration this current disparity of
health status between Indigenous
and non-Indigenous Australians and
ensure that medical students are
taught how to facilitate
culturally-appropriate healthcare in
order to assist the improvement of
Indigenous health outcomes.
Background
• CDAMS Indigenous Health Curriculum
Development Project (2003)
• CDAMS Indigenous Health Curriculum
Framework (2004)
• AMC Accreditation Standards
Endorsement of IHCF(2004)
• AMC Re-endorsement (2007)
• University Curriculum developments
– University of Newcastle
– University of Western Australia
– James Cook University
Structure of the Project
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Project Outline
Literature Review
Ethics Approval
Data Gathering
Data Analysis
Thesis Writing
Recommendations
Rationale for the Project
• Identified gap in the literature
– Limited investigation into students’
experiences of Indigenous health
curricula
• Significance of CDAMS
Indigenous Health Curriculum
Framework implementation
• Recommendations from
Government bodies for inclusion
of appropriate Aboriginal health
teachings in medical courses
Aims of the Project
• To examine a cohort of
Monash medical students’
experiences of the
Indigenous health
curriculum of the Monash
MBBS course through the
use of semi-structured
interviews with current
medical students
Aims of the Project
• The project intended to assess
– What exposure students have had
– Their understanding of the
rationale behind including
Indigenous health within the MBBS
curriculum
– Their interpretation of the meaning
of Indigenous health teachings in
the context of the broader MBBS
course
• Compare students’
experiences with audited
Indigenous health curricula &
CDAMS IHCF
• Provide feedback to Faculty
Literature Review
• Kamien,1975, Education in community medicine with an
emphasis on the health of an Aboriginal community: a pilot
project
• Kaufman, 1984, Medical students and Aborigines: can prejudice
be reduced?
• Copeman, 1989, Medical students, Aborigines and migrants:
evaluation of a teaching programme
• Jamrozik, 1995, Going bush – helping medical students learn
from Aboriginal people
• Garvey & Hazell, 1997, Developing rapport: Aboriginal camps for
medical students
• Rasmussen, 2001, Towards reconciliation in Aboriginal health:
initiatives for teaching medical students about Aboriginal issues
• Paul, Carr & Milroy, 2006, Making a difference: the early impact
of an Aboriginal health undergraduate medical curriculum
Literature Review
• International
– New Zealand (Otago University)
– Canada
– United States of America
• Phillips, 2004, CDAMS Indigenous Health
Curriculum Framework
• Phillips, 2004, CDAMS Indigenous Health
Curriculum Development Project: National
Audit and Consultations Report
• Wilson, 2006, CDAMS Indigenous Health
Curriculum Review – Mapping exercise
examining Indigenous health content in
the MBBS
Methodology
• Qualitative data
– Semi-structured interviews
• Criterion sampling
– Active clinical medical
student
– Previous exposure to
Indigenous health curriculum
– Based in Gippsland during
2007
• Volunteer sampling
Semi-Structured Interviews
• Audio-taped
• Themes
– Exposure to Indigenous
Health
– Understanding of the
rationale behind inclusion of
Indigenous Health within the
MBBS
– Experience and meaning of
Indigenous health in the
context of the broader MBBS
course
Methodology – Data Analysis
• Miles and Huberman Framework
for Qualitative Data Analysis (1994)
– Data Reduction
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Editing
Coding and memoing
Identifying themes
Conceptualising and explaining
– Data Display
– Drawing and Verifying conclusions
• Thematic analysis
• Inductive and Deductive
Results – Background Info
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12 interviews
Origin – Rural (58%), City (42%)
Year Level – III (50%), IV (50%)
Only 3 students had had
significant prior contact with
Indigenous people
• Year IVs reported more
Indigenous health teachings
Results
CDAMS Subject Area
CDAMS
Audit
(2003)
Monash
Review
(2006)
Student
Experience
(2007)
1. History
Y–L
Y–L
Y–L
2. Culture, Self and
Diversity
Y – FT
Y–L
N
3. Indigenous Societies,
Culture and Medicine
Y – FT
Y* – FT
Y – FT, RS
4. Population Health
Y–L
Y–L
Y–L
5. Models of Health
Service Delivery
N
N
Y* – RS, SPC
6. Clinical Presentation of
Disease
Y – PBL, O Y – PBL,
PV, SPT
Y – PBL, SPC
7. Communication Skills
Y – O, PV
Y – PV
Y – O, SPT
N
N
N
8. Working with Indigenous N
Peoples – Ethics, Protocols
and Research
Key Themes
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Integration
Temporality
Clinical relevance
Locality
City-Neglect
Delivery
Authenticity and Credibility
Hidden curriculum
Student Reported Barriers
• Poor integration of Indigenous health
across all themes of the MBBS course
• Teaching Indigenous health only in a
rural context
• Providing teaching focused on the preclinical years
• Locating a lot of Indigenous health
teaching only within electives
• Dictating teaching methods
• Authenticity of the teacher (in some
cases)
Student Reported Facilitators
• Integrating Indigenous health across all
themes of the course
• Interactive teaching methods
• Using teaching staff who have experience
and passion regarding Indigenous health
• Appropriate involvement of Indigenous
people including providing adequate
briefing
• Providing opportunities for clinical
experience in Indigenous health
• Offering electives, on top of the core
curriculum, for students with demonstrated
interest in Indigenous health
Recommendations
• Undergo further curriculum evaluation
and development
• Expand Indigenous health teachings to
ensure all students are able to satisfy
IHCF standards
• Ensure adequate horizontal and
vertical integration
• Re-emphasise the clinical relevance of
Indigenous health
• Introduce tutorial-based, interactive
learning opportunities
• Ensure that both rural and urban
perspectives of Indigenous health are
taught
Recommendations
• Use teaching staff with experience
in and demonstrated passion for
Indigenous health
• Increase the representation of
Indigenous people within the
Faculty
• Involve Indigenous people
appropriately ensuring adequate
briefing
• Improve the training for tutors
(e.g. PCL)
• Offer additional learning
opportunities for students with a
demonstrated interest
Limitations
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Small participant group
Only 2 year levels
Effect of recall bias
Rural Clinical School
students
• Relationship between
participants and
researcher
Areas for Further Research
• Larger sample size
• Longitudinal tracking
– Undergraduate
– Post-graduate
• Impact of outside exposure
• Influence of prior exposure
to Indigenous people
• Effect of curriculum on
student attitudes regarding
Indigenous issues overall
Conclusion
• Unfavourable comparison
between:
– Monash vs. CDAMS IHCF
– Students vs. Documented curriculum
• Factors deemed by students to
influence their learning in
Indigenous health
• Need for additional
development and ongoing
evaluation of curriculum
• Further research necessary
References
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Australian Bureau of Statistics (2007). Year Book Australia
2007. Retrieved [2 June 2007] from
http://www.abs.gov.au/Ausstats/[email protected]/Latestproducts
/1301.0Main%20Features12007?opendocument&tabnam
e=Summary&prodno=1301.0&issue=2007&num=&view=
Phillips, G.L. (2004). CDAMS Indigenous Health Curriculum
Framework. Melbourne: VicHealth Koori Health Research
and Community Development Unit, University of
Melbourne
Green, J. and Thorogood, N. (2004). Qualitative Methods
for Health Research, Chapter 8, London, Sage.
Liamputtong, P. and Ezzy, D. (2005). Qualitative Research
Methods, Chapter 12, Melbourne, Oxford.
Minichiello, V. et al (1995). In-Depth Interviewing,
Melbourne, Longman.
Punch, K. (2005). Analysis of Qualitative Data, Chapter 10,
Sage [electronic resource] Accessed 16/July/07 via
Monash University Digitised Collection
Snyder, B. (1971). The Hidden Curriculum, New York,
Knopf.
Wolcott, H.F. (1994). Transforming Qualitative Data:
Description, Analysis and Interpretation, Chapter 4,
Thousand Oaks: CA, Sage. Accessed 16/July/07 from:
www.ehr.nsf.gov/EHR/REC/pubs/NSF97-153/CHAP_4.HTM