Embedding Indigenous Health within a New Medicine Program

Embedding Indigenous Health within a New Medicine Program Philip Jones & Lisa Jackson-Pulver Faculty of Medicine, UNSW

UNSW Medicine Program n 6 -year UG program n Three phases. n Modular structure (8 -week courses). n Common organising domains in Phases 1 & 2 with recurring themes. n Vertical integration.

Graduate Capabilities Using basic and clinical sciences. n Social/cultural aspects of health & disease. n Patient assessment and management. n Effective communication. n Team work. n Self-directed learning and critical evaluation. n Ethics and legal responsibilities. n Becoming a reflective practitioner. n

Graduate Capabilities Relating to Indigenous Health n Awareness of cultural issues. n Reflections on personal value system. n Cultural sensitivity, tolerance and respect for others. n Communicates effectively with culturally diverse patients and families.

Phase 1: Scenario based learning Health scenarios provide a context for learning activities. n Predominantly campusbased activities. n Scenario groups. n

Phase 1 learning activities related to Indigenous Health n Scenarios illustrating health problems affecting Indigenous people ¨ Teenage pregnancy ¨ Child development ¨ Weight control and diabetes ¨ Alcohol-related disorders

Teenage Pregnancy Scenario n Jessica is an Anglo-Celtic girl living in a small country town and is in year 9 at the local high school. She is worried that she is pregnant because her period is two weeks overdue. n Deborah is an Aboriginal girl living in western Sydney as part of an urban Aboriginal community. She is 22 weeks pregnant and attends an Aboriginal Medical Centre. Doctors are worried because her fetus may be small for her apparent dates.

Phase 1 learning activities related to Indigenous Health n Lectures ¨ Lecture on diabetes from an Indigenous speaker n Small group sessions ¨ Viewing and discussing “Lonely Boy Richard” n Communication skills tutorials

Phase 1 assessment activities n Individual assignments ¨ Trachoma & equity in child health. ¨ Rheumatic heart disease in Indigenous Australians - a third world disease in a first world country. n Group projects ¨ Planning a health promotion and education campaign on nutrition and/or weight control for type 2 diabetes. ¨ Evaluate campaigns to reduce risky alcohol consumption among specific sub-populations.

Phase 2: Practice based learning n n n Structured clinical experiences based on weekly themes. Linking to biomedical sciences on campus. Independent learning project.

“Cross cultural and Indigenous health” theme in Phase 2 n Lectures ¨ Overview of Indigenous health ¨ Common health problems especially skin problems. n Communication skills tutorials ¨ Case studies involving Aboriginal health workers. n Case method tutorial

n n n This is the story of how several remote Indigenous communities made efforts to control skin infections in their community members, particularly their children. Chronic scabies and the resulting streptococcal skin infections are a significant cause of longterm serious health complications. The community of Minjilang on Croker Island in Torres Strait tried a health intervention to reduce the prevalence of these infections. The desert communities of the Kimberley in Western Australia tried an environmental intervention.

Phase 2 assessment activities n Group project ¨ Analysis of a Health Problem in a Local Population n Station in Phase 2 Integrated Clinical Examination ¨ Evaluate communication skills in interview of aboriginal patient.

Phase 3: Independent reflective learning Clinical clerkships. n Hospital and community settings. n Flexibility in choice of courses within guidelines. n

Portfolio Assessment Students required to demonstrate evidence of achievement for graduate capabilities. n Reflective essay on learning and development of graduate capabilities. n

Conclusions n n Outcomes-based curriculum with graduate capabilities linking to Indigenous Health. Learning activities relating to Indigenous Health within different courses across each phase of the curriculum. Learning activities involving Aboriginal patients and health care workers. Increased awareness and understanding of issues affecting Indigenous Health.