CRT Draft Document
INDIGENOUS HEALTH PROJECT - CRITICAL REFLECTION TOOL
DRAFT
13 September 2007 - Revised to include pilot study results
Table of Contents
- The context of the medical schools
- Indigenous health unit—location and brief 1B. Indigenous community partnerships
- Human resources
- Teaching capacity and professional development
- Induction and training—including cultural safety
- Funding for teaching
- The outcomes of the medical course
- Mission statement 16
- Executive co-ordination based on the principle of Indigenous leadership, faculty responsibility
- The medical curriculum
- Indigenous health as core curriculum
- Curriculum maps, student outcomes and attitude statements
- Curriculum design co-ordination
- Teaching and learning N/A
- Assessment of student learning
- Assessment of Indigenous health content
- The curriculum- monitoring and evaluation
- Review and evaluation
- Indigenous students
- Recruitment
- Alternative entry scheme
- Admission policy and selection
- Support, mentoring, networks and counselling
- Financial support
- Co-ordination of Indigenous student support
- Implementing the Curriculum- clinical placement
- Community engagement, clinical placements
1A. The context of the medical schools: Indigenous health unit - location and brief
Background
The organisational arrangements and the location (structurally and physically, on/off campus), of Indigenous health units/programs varies between faculties/schools. This positioning affects the role of the Indigenous health units/programs in terms of their teaching brief, faculty/school-wide co-ordination, accessibility and resource allocation.
Key Questions
- Does your faculty/school have an Indigenous health unit?
- Where is the Indigenous health unit located, structurally and physically?
- What is the unit’s teaching brief?
Reference
CF 1, 2, 4, and 5 / AMCG 1.4
Examples
Example 1
The Indigenous health unit at a large medical school originally had a Faculty-wide brief. With a restructure the unit was relocated to the school of rural health. As a result, the unit lost the ability to coordinate and influence Indigenous health developments throughout the Faculty, while increasingly being expected to teach throughout the curriculum, across the Faculty, with the resources and brief of a school unit only. While it is encouraging that more schools and departments want this unit to help them teach Indigenous health, it is not realistic unless the unit’s brief is elevated and resourced to meet the whole-of-Faculty demand.
Example 2
A medical school started with one lecturer in Indigenous health based in a rural health school. With the Dean’s support, the lecturer was able to build significant partnerships with the Indigenous health general education centre on campus, and attract external resources to employ administrative support staff. In addition, the Dean allocated core funding to academic staff to assist with the growing teaching load, and to map Indigenous health across the curriculum. Through the tenacity of the Indigenous health lecturer and the Dean’s funding and strategic commitments, the Faculty is swiftly moving towards a comprehensive and well-resourced Indigenous health strategy (curriculum and Indigenous student support initiatives).
Example 3
In recognition of the importance of Indigenous health within its curricula, a medical school made the decision to include Indigenous health in the school’s title. This entailed the development of an Indigenous health unit, which resulted in the employment of more Indigenous staff, as well as an opportunity for increased coordination across the medical curricula and greater collaboration with course coordinators. This change allowed for Indigenous health to be seen as the responsibility of all staff in the medical school.
Questions
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With reference to the key questions in the preceding page, describe your current practice.
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What are the contextual factors that influence your practice (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
1B. The context of the medical schools: Indigenous community partnerships
Background
Partnerships with local Indigenous organisations and communities need to be developed in order to facilitate the most effective learning. Grounding Indigenous health in local contexts will enable the faculty/school to improve the quality of learning, facilitate specific strategies like community placements, and demonstrate its commitment to Indigenous health. Well-managed partnerships of this nature are also likely to enrich Indigenous students’ experience on campus.
Key Questions
- What partnerships exist between your faculty/school and Indigenous communities or organisations?
- How are these partnerships fostered and nurtured?
- Do these partnerships contribute to the curriculum, and how?
Reference
CF 7/ AMCG 1.4 and 1.6
Examples
Example 1
A new medical school with no Indigenous staff contacted the general university Indigenous education centre to facilitate a meeting with some local Indigenous health organisations. This resulted in the establishment of a community reference group. The reference group included staff from the local Aboriginal Medical Service (AMS), Indigenous Elders and community health workers, Faculty staff, a government representative, and a member of the Australian Indigenous Doctors’ Association (AIDA). The reference group assists the medical school in selecting and supporting Indigenous students, designing locally appropriate Indigenous health curriculum, and making the whole Faculty aware of Indigenous health issues in areas like research ethics. The reference group members receive payment for any lectures or seminars they give and are offered adjunct lectureships where appropriate. They also have the capacity to streamline the co-ordination of student placements through the AMS. In return, they find it very valuable to be teaching medical students about their community’s needs and health care in general.
Example 2
With the help of an Indigenous staff member, an established medical school started a successful community relationship. They have found that the partnership requires true commitment and respect to each other’s needs, and that sometimes they cannot meet all of the community’s requests. In this situation, the Indigenous academic and support staff were best placed to initiate, broker and develop partnerships and ongoing relationships. However, such partnerships should be coordinated and medical schools must be mindful that partnerships of this nature will require time, and that staff (Indigenous and non-Indigenous) and community representatives must be adequately resourced to undertake these functions.
Questions
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With reference to the key questions in the preceding page, describe your community partnerships.
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What are the contextual factors that influence these relationships (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
1C. The context of the medical schools: Human resources
Background
Teaching Indigenous health across the curriculum will require adequate human resources and coordination. Indigenous staff should be employed across the faculty/school in a spectrum of roles and seniority.
Key Questions
- Are there staff specifically allocated to teach Indigenous health?
- How many Indigenous staff are employed in academic (including teaching Indigenous health), student support and administrative roles?
Reference
CF 2, 3, 5, 6 and 8 / AMCG 1.4, 1.7, 1.8 and 1.9
Example
Example 1
With the assistance of 1.0 FTE academic, an Indigenous health unit was established. The unit’s focus was to develop core curriculum, and then to branch into other areas. From the beginning, the unit consisted of Indigenous academics. Collaborations with non-Indigenous academics have been instigated within fields where Indigenous health perspectives are essential. There are now 3 lecturer positions (senior lecturer and lecturers) and a teaching fellow position in the unit, and a 0.5 FTE position is currently dedicated to an administrative role. The teaching coming directly from the unit has allowed the Indigenous teaching framework to have a significant presence within the medical school, evidenced by a visible location.
Questions
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With reference to the key questions in the preceding page, describe your current staffing arrangements.
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What are the contextual factors that influence your current practice (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
1D. The context of the medical schools: Teaching capacity and professional development
Background
Indigenous staff can be used optimally as co-ordinators and to train others to perform the separate functions required in the teaching of Indigenous health and associated tasks, avoiding the expectation that Indigenous academic staff perform all tasks related to Indigenous health. Indigenous academic and general staff will require recognition, adequate support, and professional and career development opportunities.
Key Questions
- What strategies has the faculty/school implemented to ensure there is adequate support for Indigenous staff?
- What mechanisms, through coordination and or professional development can be implemented to maximise resources and manage the workload.
- What professional and career development opportunities exist for Indigenous staff members?
Reference
CF 2, 3, 5, 6 and 8 / AMCG 1.4, 1.7, 1.8 and 1.9
Examples
Example 1
An established medical school has recently begun revamping its Indigenous health strategy: they have developed a close partnership with the general Indigenous education centre; they use an existing Indigenous partnership group to assist in curriculum design; and they utilise their one Indigenous full time academic to train non-Indigenous staff in an appropriate Indigenous framework. They also contract extra sessional teachers when required. These strategies are cost effective and are carried out in a supportive environment.
Example 2
A postgraduate medical school employed an Indigenous health academic to integrate the ‘CDAMS Indigenous Health Curriculum Framework’ project across its curricula. The medical school then reviewed the aims and objectives of the academic position and realised they were complex. In recognition of that, and the importance of Indigenous health, the medical school decided to upgrade the position to Associate Professor and to increase the number of Indigenous staff.
Questions
-
With reference to the key questions in the preceding page, describe your current practice.
-
What are the contextual factors that influence your practice (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
-
What would you like to achieve or what needs to be done (goals, objectives)?
-
How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
1E. The context of the medical schools: Induction and training - including cultural safety
Background
The attitude of all teaching, clinical and administrative staff counts towards effective learning. Staff who design, deliver, evaluate and administer the Indigenous health curriculum should be confident, informed and committed to improving Indigenous health outcomes. All staff will require training in the goals and intent of the faculty/school’s Indigenous health strategy, and encouraged to become active participants in the process. New staff should be inducted and trained on the principles of the curriculum framework.
Cultural Safety is about ensuring that individuals and systems who deliver health care are aware of the impact of their own cultural values on the delivery of services, and that they have knowledge of, respect for, and sensitivity towards the cultural needs of others. Faculty/Schools should recognise that the need for cultural safety training is ongoing. Indigenous health and the cultural safety needs of Indigenous communities should not be subsumed in general cultural safety teaching.
Key Questions
- What opportunities are available to induct, train and encourage all staff in the area of Indigenous health?
- What training is available that specifically addresses cultural safety?
Reference
CF 2, 3, 5, 6 and 8 / AMCG 1.4, 1.8 and 1.9
Example
Example 1
A new medical school had limited initial funding to develop an Indigenous health program. Recognising the importance that all staff participates in the development of such a program over time, they were required to attend cultural safety training. This training was initiated, developed and co-taught by two academics: one from the medical school who had experience in this area, and an Indigenous academic from the university's Indigenous studies unit. To ensure this was not a 'one-off', the developed cultural safety teaching module was integrated into the Faculty’s broader professional development program.
Questions
-
With reference to the key questions in the preceding page, describe your current practice.
-
What are the contextual factors that influence your practice (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
-
How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
1F. The context of the medical schools: Funding for teaching
Background
Indigenous health teaching should be considered a core responsibility of the medical faculty/school, reflected in the budget. In order that Indigenous health is intrinsic to the faculty/school activities and does not exist as a result of external funding and in-kind support. Resources allocated to Indigenous health should reflect the teaching brief of the unit.
Key Questions
- How are your teaching positions in Indigenous health funded?
- Do you believe you are adequately resourced to carry out the teaching?
Reference
CF 2 and 4 / AMCG 1.5.
Example
Example 1
What proportion of your funding for Indigenous health is:
1. Core Faculty funding
2. Specific University allocated funds
3. Competitive research grants
4. External project funding?
Questions
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With reference to the key questions in the preceding page, describe your current funding practice for Indigenous health.
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What are the contextual factors that influence your funding and are you adequately resourced to carry out the teaching (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
2A. The outcome of medical courses: Mission statement
Background
A mission statement outlines the faculty/school’s goals and approach to Indigenous health. It identifies how these goals are embedded in the life of the faculty/school as a core function of the corporate plan.
Key Questions
- Does your faculty/school mission statement and strategic plan articulate a commitment to Indigenous health teaching and learning?
- Are there other ways/fora that this commitment is expressed?
Reference
CF 1, 2, 3, 4, 5, 6, 8 and10/ AMCG 2.1
Examples
Example 1
A medical school has publicly stated that Indigenous health is one of the areas that its graduates should make a difference. The school has included in its mission statement and strategic plan a commitment to improving Indigenous health outcomes through the provision of quality medical education. The school is still developing specific initiatives to implement its mission statement and strategic plan, including employing Indigenous staff and identifying senior staff to lead and drive the process. The strategic documents give the staff, students and stakeholders an understanding that positive values and attitudes towards Indigenous health teaching and learning are a core component of the curricula.
Questions
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With reference to the key questions in the preceding page, please describe how your faculty/school’s commitment to Indigenous health is expressed and documented.
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
2B. The outcome of medical courses: Executive coordination based on the principle of Indigenous leadership, faculty responsibility
Background
Medical faculties/schools would benefit from clearly identified leadership, responsibility and reporting structures for the coordination, and implementation of an overarching Indigenous health strategy (including curriculum, student admission, recruitment and support, teaching and research etc.). Indigenous staff are a critical part of, but not responsible for, the strategy. Whole-of-school partnerships require engaging staff across the institution to work collaboratively to actively promote the spirit and intent of the Curriculum Framework and the Healthy Futures reports.
Key Questions
- Whose provides leadership within the Faculty to ensure that an overarching Indigenous health strategy is implemented (including recommendations of the Curriculum Framework and the Healthy Future report)?
- In terms of process, would you describe this as a collaborative faculty/school approach, or is there a reliance on a particular person(s)?
Reference
CF 4, 5 and 6/ AMCG 2.1, 1.2, 1.3 and 1.4
Examples
Example 1
A medical school has designated an Assistant Dean for Indigenous Health (an Indigenous person) at the faculty level to undertake all Indigenous health teaching, research, Indigenous student affairs and community engagement projects across the health sciences. This person negotiates effectively with heads of school across the health disciplines for the development of curricula and Indigenous student recruitment and retention. The medical school has employed an Indigenous person as a student support officer, and a part-time academic to assist in teaching.
Example 2
A medical school has demonstrated a commitment to Indigenous health by employing an academic to undertake Indigenous health curriculum development. The various tasks involved in curriculum development, Indigenous student recruitment, retention and support, as well as other strategic matters, has proved to be a very large workload. The staff member has presented the need for a coherent Indigenous medical education strategy to the Dean, who is supportive, and to senior management at faculty/school and university levels. However, the active promotion of Indigenous health teaching and learning is undermined by the lack of strategic and planning documents.
Questions
-
With reference to the key questions in the preceding page, describe your current practice.
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What are the contextual factors that influence your practice (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
3A. The medical curriculum: Indigenous health as core curriculum
Background
The Medical Deans Indigenous Health project is a response to recommendations from numerous studies, inquiries, reports, policies and strategies emerging from the fields of Indigenous health, medical education and medical workforce development. Over the last few decades, these documents have consistently recommended the development and strengthening of both core and vocational medical education, regarding the health and wellbeing of Aboriginal and Torres Strait Islander Australians, and Maori in New Zealand.
Key Questions
- Is there core Indigenous health content to which every medical student will be exposed?
- Do students have a choice to follow up their Indigenous health interest in electives?
- What are the factors that influence the delivery of a quality curriculum?
Reference
CF 1, 2, 3, 4, 5 and 7 /AMCG 1.3 and 1.4.
Example
Example 1
With the CDAMS Indigenous Health Curriculum Framework guiding redevelopment, Indigenous health is a compulsory component of the curriculum. Indigenous health has discrete sessions that include a cultural safety aspect and an introduction to Indigenous health. Indigenous health is also integrated into a number of key topic areas such as: holistic models of health care and health determinants, comprehensive primary health care rural health, cardiovascular disease and risk factors, chronic conditions, and mental health. Discrete sessions have specific identified learning objectives, case based learning (CBL) and case questions. Cultural safety from an Indigenous perspective is introduced in first semester first year. Field trips offer opportunities for one CBL group who then reports back to the whole cohort and presents an abstract. All sessions are delivered by Indigenous people and/or medical practitioners working in the area.
Questions
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With reference to the key questions in the preceding page, describe your current practice in terms of core and elective Indigenous health content.
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What are the contextual factors that influence your practice (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
3B. The medical curriculum: Curriculum maps, student outcomes and attitude statement
Background
Indigenous health teaching and learning should be embedded in curriculum maps, student outcome, and attributes statements. This establishes a structure for coherent learning plans and outcomes and provides a measurement for quality assurance and accreditation purposes.
Key Question
- Is Indigenous health incorporated in the faculty/school’s curriculum planning documents and overall student attribute and outcome statements?
Reference
CF 2, 4, 5, 6 and 7/ AMCG 1.3 and 3.1
Examples
Example 1
Until a recent redevelopment of the curriculum, there was no structured Indigenous health teaching at an established university. Teaching was based on the ‘goodwill’ and the personality of certain individuals within various faculty units. The Dean wanted to formalise the teaching of Indigenous health throughout the medical program and ensured that this was reflected in the new curriculum. These changes were driven by the Dean and initiated at a time when there were no Indigenous staff members in the faculty. This allowed for the groundwork to be laid before an Indigenous employee came on board, which also increased the appeal of the university to other Indigenous academics and students. The entire curriculum has recently been mapped and today comprises scenario based learning, where all cases (Indigenous and not) are presented to students and learning is gained by structured experiences. Such experiences include the patients, their families and communities in the context of their home, school and work, across the lifespan. These scenarios demonstrate the complexity experienced by individuals engaging with health and illness in our society.
Example 2
An established medical school redeveloped its curriculum to introduce greater teaching and learning opportunities in Indigenous health. Using a stepwise learning pathway, graduate and year level learning outcomes in Indigenous health were developed. These have been used to guide the implementation of a comprehensive vertically and horizontally integrated curriculum. Learning is situated within existing units in each year of the course, with year and graduate level outcomes. The initial progress was quick and relatively easy, drawing on existing partnerships and some opportunistic development of new partnerships with unit coordinators who were ‘on side’.
Questions
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Describe how Indigenous health has been incorporated in the faculty/school’s curriculum planning documents and overall student attribute and outcome statements?
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What are the contextual factors that influence the process of incorporating Indigenous health teaching and learning documentation (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
3C. The medical curriculum: Curriculum design co-ordinationWith reference to the key questions in the preceding page, describe your current practice.
Background
The co-ordination of Indigenous health content across the curriculum is important to ensure a stepped, developmental approach. Indigenous health content should be vertically integrated such that a ‘staircase’ approach is taken, where foundation or basic learning in the earlier years is built upon to more advanced skills. Indigenous health content can be horizontally integrated to the broader curriculum. This can be identifiable in curriculum maps. Indigenous staff should participate in the design, delivery and evaluation of curriculum content. Content should be locally accurate as well as broadly translatable to a national context where appropriate.
Key Questions
- Does the faculty/school have a process to ensure the co-ordinated design, delivery and evaluation of the Indigenous health curriculum?
- What involvement do Indigenous staff and community members have in this process?
Reference
CF 2,4,5,6,7,8,9 and 10/ AMCG 1.3, 1.4 and 3.3.
Example
Example 1
By utilising a stepped learning outcome model (at both year and graduate levels), an established school was able to develop and implement a six year curriculum that provided a solid framework for teaching and learning in Indigenous health. This task was made easier by strong executive support and a well-supported Indigenous health unit and some strong initial partnerships with existing unit coordinators. This was and continues to be informed by Indigenous perspectives in planning, implementation and evaluation. Building on that framework, with the aim of embedding Indigenous health learning opportunities across a wider spectrum of units, has been less successful.
Questions
-
With reference to the key questions in the preceding page, describe your current practice.
-
What are the contextual factors that influence your practice (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
-
What would you like to achieve or what needs to be done (goals, objectives)?
-
How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
5A. Assessment of student learning: Assessment of Indigenous health
Background
The inclusion of Indigenous health in the broader curriculum necessitates specific assessment requirements for the Indigenous health component.
Key Questions
- How is student understanding of Indigenous health assessed?
- Is this reflected in an overarching assessment map across the medical course?
- Is your current assessment appropriate/adequate?
Reference
CF 2 and 4 /AMCG 5.1, 5.2, 5.3 and 5.4
Examples
Example 1
All first year students are required to submit an abstract on Indigenous health. Work is marked, reviewed and included in the student's portfolio. Indigenous health is assessed in a summative way using short answer questions. A short answer question is developed covering the broad thematic areas as a case introduction. Separate stems are then added to the introduction with individual theme areas.
Example 2
Students are explicitly assessed on their knowledge of Indigenous health and history through an essay question, which is supported with reference material and lectures. Development of professional practice is assessed through an Objective Structured Clinical Examination (OSCE), which has cross-cultural communication as its focus. Leading up to the OSCE, students are exposed to interviews with Indigenous Simulated Patients.
Example 3
Indigenous health is used as an example to teach some elements of population health and understanding of demography. Students are assessed in an exam with questions that ask them to reflect on field visits, or during Problem Based Learning (PBL) sessions, and they may use an Indigenous case as examples. Equally, they may use a different demographic case as an example. However, the principles around population health demographics are assessed.
Example 4
In addressing learning needs in the domain of ‘the scientific basis of medicine’, a PBL with a biomedical focus on diabetes is used. The demographics of the case are based on an Indigenous example, and the students are assessed on this through the completion of the PBL, as well as exam questions.
Questions
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With reference to the key questions in the preceding page, describe your current assessment practice in Indigenous health teaching and learning.
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What are the contextual factors that influence your assessment practice (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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Is your current assessment appropriate/adequate and what would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
6A. The curriculum-monitoring and evaluation: Review and evaluation
Background
The regular evaluation of Indigenous health curriculum is important. A partnership between community groups, and staff charged with the design and delivery of the Indigenous health content will assist with the development of evaluation tools and methodologies. Partnerships between staff and community representatives are critical to this process. Evaluation tools might include qualitative feedback from staff, students and community members, as well as statistical profiles of participation in subjects, camps, seminars, and student results over time.
Key Question
- What evaluation measures do you undertake of your Indigenous health curriculum content?
Reference
CF 1, 2 ,3 ,4 ,5 ,6 and 7/ AMCG 1.4, 6.1 and 6.3
Examples
Example 1
At a university, an Indigenous Health Committee was established as an advisory board. The task of this board is to assist the development and implementation of the Indigenous health curriculum content within the Faculty, at undergraduate and postgraduate levels. The committee comprises a number of staff members, including heads of schools (from Indigenous health, rural health, and broader health sciences), senior lecturers, and an Indigenous student support officer. An internal review was conducted which addressed Indigenous health content, the results were forwarded to the committee. This process resulted in the identification of ‘gaps’ in teaching, and facilitated the identification of ‘out of date’ or ‘stereotypical’ content. As well as an assessment of a ‘culturally safe’ curriculum.
Example 2
Following curriculum evaluation, case presentations have replaced the submission of abstracts during weeks of discrete learning activities. This enables students to share learning with the whole cohort. However, owing to poor attendance a reintroduction of the abstracts is currently under consideration. Field trips are dependent on local infrastructure and management, and staff support that may change from year to year. The small and limited numbers of organisations require support and engagement on an ongoing basis and with this experience a revised strategy is currently being designed.
Questions
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Describe what evaluation measures you undertake of your Indigenous health curriculum content.
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What are the contextual factors that influence your practice including community partnerships in the evaluation process (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
7A. Indigenous students: Recruitment
Background
The significant disparity in the health status between Aboriginal and Torres Strait Islander people and the general Australian population is widely acknowledged. The positive effect of Indigenous doctors on the physical, emotional and cultural wellbeing of Indigenous people has been widely recognised. One way that medical faculties/schools can address this health inequity is by the active recruitment of Indigenous students to both undergraduate and postgraduate courses. It is important that universities promote medicine as a viable career option for Indigenous students of all ages. This may be achieved through school visits, targeted information, career days, orientation days and workshops and by demonstrating that support is available for interested students.
Key Question
- What does your faculty/school do to actively promote medicine as a career choice to prospective Indigenous students?
Reference
HF 3.4, 4.2: 4.3: 4.3.1; 4.3.2; 4.3.3; & 4.4.1/ AMCG 7.1 and 7.2
Examples
Example 1
The university runs pre-med courses and has intensive summer courses available to prospective students. This is paired with orientation programs where students have the chance to meet with local community groups, visit the Indigenous Support Unit and familiarise themselves with staff available to assist them with housing, scholarships, Indigenous Tutorial Assistance Scheme (ITAS) and other support. The university has found that key to the success of recruitment strategies is the close collaboration between the Indigenous Health Unit and the Indigenous Support Unit (co-location helps), and the existence of multiple pathways. This ensures that entry options are tailored to individual students’ needs, (i.e. this is not just a school-to-university program). The university also targets regional career days, organises school visits and has close ties with relevant community groups.
Example 2
A medical school offers information sessions highlighting available support for Indigenous students in science and health related courses. Medical students and recent graduates encourage potential students to consider medicine as a career. The course is advertised to prospective students through appropriate media such as The Koori Mail, the National Indigenous Times and on AIDA’s website. The medical school approaches high school principals and career advisers to highlight medicine as a career option, outlining available support. It also holds orientation days and camps for potential Indigenous students. Information is distributed through the Aboriginal Medical Service (AMS). The university employs local Indigenous people to assist with the development of recruitment, retention, support and teaching strategies. Good community relationships and effective consultation have dramatically increased Indigenous student recruitment and retention.
Questions
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Describe what does your faculty/school does to actively promote medicine as a career choice to prospective Indigenous students.
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What are the contextual factors that influence the promotion of medical studies amongst Indigenous students and their recruitment?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
7B. Indigenous students: Alternative entry scheme
Background
Whilst Indigenous students may attain a tertiary entry rank that will gain them a place in a medical course, many are not familiar with the university system, and may be hesitant to apply believing they would not achieve a place. At the same time there are many reasons (including structural disadvantage), why Indigenous students do not attain cut off entry scores. It is desirable that universities have alternative entry schemes that ensure Indigenous students are accommodated within the medical faculty/school’s overall student quota.
Key Question
- What alternative entry schemes are available to Indigenous students?
Reference
HF 4.3.3; 4.5.1; 4.5.2; and 4.5.3 / AMCG 7.1 and 7.2
Examples
Example 1
The university has a designated number of places for Indigenous students. These places are part of the overall student quota and may not be re-allocated to non-Indigenous applicants. The university also has clearly articulated pathways into medicine for applicants who have a degree or vocational experience. The university provides support for prospective applicants with bridging and pre-med courses, and offers tutorial assistance for the GAMSAT/UMAT. The GAMSAT/UMAT is a significant barrier to entry for Indigenous students. At the university, only 1 out of 24 Indigenous students gained a place via the standard UMAT, UAI/TER, Interview process, and only 3 achieved a ‘competitive’ UAI/TER.
Example 2
The university has found that having alternative entry schemes enables the recruitment of students from a variety of backgrounds. This leads to greater Indigenous student enrolments, and fosters better and lasting relationships with the community.
Questions
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Describe what alternative entry schemes are available to Indigenous students.
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What are the contextual factors that influence the establishment of an alternative entry scheme (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
7C. Indigenous students: Admission policy and selection
Background
Support services and flexible tools are needed to facilitate the selection of appropriate Indigenous students. These selection tools should be developed with input from Indigenous communities and Indigenous student support units.
Key Questions
- What are the selection tools and how are they weighted?
- Are such tools the result of a consultative process?
Reference
HF 4.3.1; 4.3.3; 4.5.1 and 4.5.3/ AMCG 7.1 and 7.2
Examples
Example 1
The university uses GAMSAT/UMAT and has a flexible approach with interviews, which are often run off campus. The university has relevant Indigenous community members on interview and selection panels. It takes into account vocational experience when considering applications and offers support in preparation for GAMSAT/UMAT. The university has a bridging/enabling course for applicants. The university has well established contacts with the Australian Indigenous Doctors’ Association (AIDA) for student support and mentoring programs and supports its students financially to attend AIDA activities.
Example 2
The university relies on UAI/TER alone for selection. The university has no Indigenous students and feedback from unsuccessful applicants is that entry is too competitive and narrow. The university is looking at expanding its selection tools for next entrance round.
Example 3
The university does not use UMAT and relies on UAI/TER and a structured interview in its selection process. The university offers a bridging course, and in some cases will suggest applicants undertake a first year science degree in order to develop their knowledge base and demonstrate their commitment and capacity. The university will ‘reserve’ a place for them subject to successful completion of that year.
Example 4
A university found that flexible approaches to the selection of students maintained high standards of graduates and as a by product a greater number of Indigenous students were retained throughout the medical courses. Students felt supported and had services to approach when they faced any difficulties. Flexible approaches to selection allowed for lasting relationships with communities to be developed and helped to set up networks, the recruitment of more students, allowed for liaison with Aboriginal Medical Services, and developing better procedures around alternative entry schemes.
Questions
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Please describe your selection tools and how are they weighted?
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What are the contextual factors, including community consultation, which influences your practice (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
7D. Indigenous student: Support, mentoring, networks and counselling
Background
Medical students may encounter stressors that can affect their general health and wellbeing. It is desirable that universities are aware of the nature of the particular stressors faced by Indigenous students. Equally desirable is the provision by medical faculties/schools of a variety of culturally appropriate Indigenous student support services and processes that are linked to other support services. Indigenous student support should include: academic support, mentoring (from graduates of medicine or other health related disciplines and other students), safe meeting places, networking and peer support, counselling, as well as physical, emotional, social, cultural and spiritual support.
Key Question
- What support is in place for Indigenous students at faculty and university levels?
Reference
HF 4.3.1; 4.3.3; 4.3.4; 4.3.5 and 4.3.7/ AMCG 7.3
Examples
Example 1
University services ensure that extra support is available for those who are struggling emotionally and/or academically. This is provided through the Indigenous Health Unit and the Indigenous student support staff. The university has good links with the Australian Indigenous Doctors’ Association (AIDA) for external support and mentoring programs. It provides safe meeting places and regular inter-faculty meetings for Indigenous students to network. The university conducts cultural awareness training for staff to ensure culturally appropriate teaching and support is offered.
Example 2
A university has one Indigenous staff member responsible for curriculum development and teaching, student support and recruitment programs. The university recognises that this staff member is often very busy juggling student support, curriculum development and teaching Students have no one else to approach when difficulties arise and the one support staff is otherwise engaged. The university is looking at expanding its support services. Much-needed supported services should encompass a whole-of-school approach.
Questions
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Please describe what support is in place for Indigenous students at faculty and university levels?
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What are the contextual factors that influence your ability to provide support for Indigenous students?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
7E. Indigenous student: Financial support
Background
AIDA’s Healthy Futures report states that 86% of Indigenous medical graduates interviewed reported financial hardship as a significant impediment to study. When medical faculties/schools provide financial assistance to students, and guidance in the identification of scholarships, accommodation and other funding options, they have higher retention and graduation rates.
Many Indigenous students of all ages risk becoming overburdened in meeting commitments associated with study, work and family obligations. It is important that universities have support mechanisms in place to assist Indigenous students in securing accommodation, tuition and basic resources (such as for computers and travel costs) to avoid unnecessary withdrawal from the medical course.
Key Questions
- What assistance is provided to students in terms of accessing scholarships, accommodation and other financial support?
- What faculty/school scholarships are available to Indigenous students?
Reference
HF 4.6 - 4.6.3/ AMCG 7.3
Examples
Example 1
The university offers scholarships to Indigenous medical students covering fees for the duration of the course. The university’s Indigenous Student Support Unit (which is linked to medical school student support) also offers general support, and can arrange specific academic and tutorial assistance. The Unit has dedicated staff to source funding and safe accommodation. Students can access scholarship information and cadetship opportunities, and a Student Financial Officer assists with budgeting and provision of loans.
Example 2
The university has a financial support officer as part of the whole-of-school approach, including links to such services on its website. The university has had some student withdrawals, which students attribute to financial reasons. The university understands that assisting Indigenous students identify scholarships, accommodation and other funding options results in higher retention and graduation rates.
Questions
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With reference to the key questions in the preceding page, describe what financial support is available for Indigenous students.
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What are the contextual factors that influence your ability to support Indigenous students (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
7F. Indigenous students: Co-ordination of Indigenous student support
Background
A well coordinated relationship between faculty/school-based and university-wide Indigenous student support is of great benefit. This relationship, as well as the optimal use of the resources that underpin support services, is critical to the recruitment and retention of Indigenous students. The Healthy Futures report links such support to the graduation of Indigenous students.
Key Question
- What is the relationship between faculty-based and university-wide Indigenous student support services?
Reference
HF 4.3.3 /AMCG 7.3
Examples
Example 1
One university has a well-established link between its Faculty-based and its university-wide Indigenous support units. This collaboration has resulted in the successful recruitment and retention of Indigenous students. Working together has achieved much more than would have been possible if independent action had been pursued. While the Faculty-based staff are able to assist in most circumstances, their capacity to do so is limited by the small size of the unit has and its multiple commitments. The university-wide Indigenous support unit also has multiple demands placed upon it, but its larger size and the broader range of staff experience enhances its capacity to assist students.
Example 2
A university has an Indigenous Health Unit within its medical school, as well as a well-resourced university-wide unit. These two units operated in isolation whilst funding permitted. However, with a university restructure, funding for Indigenous student support was reduced. A negotiated agreement between the two units is currently being developed.
Questions
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Please describe the relationship between faculty-based and university-wide Indigenous student support services?
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What are the contextual factors that influence this relationship (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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What would you like to achieve or what needs to be done (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
8A. Implementing the curriculum: Educational resources
Background
Medicine can be taught in a way that enhances students’ understanding of Indigenous experiences and worldviews. The best strategies facilitate an understanding of Indigenous health contexts, through teaching and interactions with Indigenous people during clinical placements. Sufficient resources need to be allocated to this end and collaborations with other universities are desirable. Indigenous health frameworks are an important consideration is all settings.
Key Question
- What opportunities exist for students to learn in Indigenous health settings?
Reference
CF 1,2,3,4,6,7 and 10/ AMCG 1.4, 1.5, 1.6 and 8.3
Examples
Example 1
A medical school has few Indigenous health service placement opportunities in close proximity. It is currently planning to increase the number of experiential placements and electives for students in their clinical years. Funding opportunities are currently being sourced and partnerships being fostered to support the plan. It is anticipated that this may take considerable time and effort but is worth working towards.
Example 2
A new medical school appreciated the importance of connecting with local, rural, and remote Aboriginal Medical Services, and their affiliate agencies, to develop a student placement strategy as part of its clinical skills curriculum. Partnerships were developed over time, which allowed careful consideration of opportunities and constrains within the potential placement services. This ensured the establishment of a realistic and sustainable framework. Cultural safety training formed part of the pre-placement strategy, and identification of placement-specific cultural mentors was considered integral to the process.
Questions
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Please describe what opportunities exist for students to learn in Indigenous health settings?
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What are the contextual factors that influence your practice (issues, difficulties, limitations, such as structural barriers, resource allocation, etc.)?
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If there are currently no opportunities available, is there a plan for community engagement to facilitate student placement or experience and what would you like to achieve (goals, objectives)?
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How will you achieve your aims (strategies, plans, priorities, responsibilities, timeframe)?
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