Examining Students’ Experiences of Indigenous

Health within the Monash MBBS

Lana ProutMBBS (Hons)BMedSc (Hons)

IntroductionIndigenous 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 non-health sectors working together with Indigenous leaders and communities.

IntroductionThe 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

• 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

Editing Coding and memoing Identifying themes Conceptualising and explaining

– Data Display– Drawing and Verifying conclusions

• Thematic analysis

• Inductive and Deductive

Results – Background Info

• 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

ResultsCDAMS 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 – PVY – O, SPT

N

8. Working with Indigenous Peoples – Ethics, Protocols and Research

N N N

Key Themes

• 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 pre-clinical 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

• 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• Australian Bureau of Statistics (2007). Year Book

Australia 2007. Retrieved [2 June 2007] from http://www.abs.gov.au/Ausstats/abs@.nsf/Latestproducts/1301.0Main%20Features12007?opendocument&tabname=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