‘Integrated Medical Training in Kimberley Aboriginal Community

Controlled Health Services’

Jenny Poelina Co-ordinator

Centre for Aboriginal Primary Health Care Training Education & Research (CAPTER)

David AtkinsonMedical Educator CAPTER

Medical Coordinator RCSWA (UWA and UNDA)

Regional cooperative Formed in 1986 to provide:• Accounting, stores and pharmacy • Clinical governance• Aboriginal health worker education• Remote clinics services• Population health and Information

Technology

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Kimberley Aboriginal Medical Services Council

The Kimberley WAQuickTime™ and a

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Ref: maps.google.com.au

Health Services in the Kimberley• About twice the size of Victoria,

50,000 people, 40% Aboriginal• 6 towns, 3 with procedural care -

largely GP led services• 1 resident physician, 2

Paediatricians, 2 Surgeons, 2 Psychiatrists, 1 O&G

• 16 permanently staffed remote clinics - 10 ACCHS & 6 WACHS

• Around 30 clinics with scheduled visiting staff by both road and air

Less than optimal Less than optimal infrastructure…infrastructure…

TIP # 5:

Don’t forget to get out and about……

What has KAMSC achieved in health workforce

education?

KAMSC Centre for Aboriginal PHC Training, Education and Research

GP Registrars learning ultrasound

Pharmacy assistant

class of 2005

CAPTER staff

5th year medical students 2005

AHW students – Class of 2005

Current Training & Education in Kimberley ACCHS

• Aboriginal Health Worker (Cert III, IV, Diploma, Advanced Diploma)

• Pharmacy Assistant – for ACCHS clinics• Pharmacy students (UDRH program)• Rural Clinical School (Medical Students)• Final year GP placements, JFPP, electives etc• General Practice

– Resident Medical Officer (PGPPP)– Registrars

• Advanced Rural Skills Post GP registrars

Number of AHW graduates

• Cert III 208

• Cert IV 194

• Dip (since 2003) 76

• Med II (since1986) 67

• Adv dip in SEWB 8

Medical Education Kimberley 2002-2009

0

2

4

6

8

10

12

14

16

18

20

2002 2003 2004 2005 2006 2007 2008 2009

Year

Nu

mb

er

RCS students

PGPPP

GP reg, 6 mth FTE in ACCHS

New GPRs in ACCHSs

Other GPRs in region 6 mthFTEs

Other students:

Final year medical students - 50 per year

Elective medical students - 15-20 per year

Pharmacy - 8 per year for 4-8 weeks

Pharmacy assistants - trained as reqd by

clinics

John Flynn - 4 to 6 through KAMSC per yr

How did we get here?

Aboriginal Health Worker Training in the Kimberley

• 1970s - 1983 On the Job & short coursesCommunity selected AHWs were initially used in the community clinics & community health centres to interpret and be cultural brokers. They were taught basic obs, 1st aid & how to treat common conditions.

• 1983 - 1985 BRAMS (6 months)AHWs training was formalised and delivered on the veranda and under trees at the old convent were BRAMS established their first clinic. The AHWs graduated with a Certificate in Aboriginal Health Work

Graduates of 1983

1986 – 2000 BRAMS/KAMSCState Training Accreditation Council

Curricula1986 Meeting in Broome of the 3 AHW training providers at the time in the state (BRAMS, PAMS, EKAMS)Statewide agreement on the course content and curriculum

These basic skills & full certificate became the WA industry standard courses in Aboriginal Health Work.(training reviewed each year to ensure best practice)

In addition the Kimberley developed the “Medication II course” to help AHWs practice safely in remote clinics

1994 “Certificate III in Aboriginal Health Work” (Remote Aboriginal Community) “Advanced Certificate in Aboriginal Health Work” was offered the WAACCHO training providers (KAMSC, Marr Mooditj, Bega Garnbirringu HS and Ngaanyatjarra HS.)

1997 - customised and articulated courses

2000 - finally accredited by the WA Training Authority Council (TAC) as:

“Certificate III in Aboriginal Health Primary Health Work”

“Certificate IV in Aboriginal Primary Health Work”

2001- reaccredited as units of competence. KAMSC delivered

“Certificate III in Aboriginal Health Work”

“Certificate IV in Aboriginal Primary Health Care Practice”

“Diploma in Aboriginal Primary Health Care Practice”

“Training program in Aboriginal Primary Health Care Program work”

Training program in Emergency Skills for Remote Areas”

Training program in Counselling & Aboriginal SEWB”

2002 – 2007 National Aboriginal &Torres Strait Islander

Health Worker training review

KAMSC Inc was a key stakeholder in the National review and was a member of the technical writing team & a validation site.

2008 National Accredited Training(HLT07 Health Training Packages)

KAMSC Inc commenced delivery of the new qualifications in February 2008.

Pre 2002:• Aboriginal Health Worker training• Short term visiting medical students • Occasional GP registrars (only when

vacant positions or in private practice)• Partnership with JCU - some population

health training• New nursing course Notre Dame

University, Broome Campus

Other health professional education in the Kimberley

2002-2003 Educational partnerships• Rural Clinical School, UWA• WAGPET• Combined Universities Department of

Rural Health (the WA UDRH)

Other health professional education in the Kimberley

Medical education programs in the Kimberley

2002 2003 2004 2005 2006 2007 2008 2009 Total

RCS students * 3 students in Derby

1 (pilot)

4 6 8* 7 11* 11* 11* 59

PGY2/3 10wk terms ACCHS & Hospital (Public health Š 5mth terms)

0 (2) 0 (2) 0 (2) 0 (2) 4 (2) 6 (2) 8(2) 14(2) 22 (16)

GP Registrars 6 month FTE posts in ACCHSs

0 4.5 8.5 11.5 15 19 12.5 18.5 89.5

Number of new GPRs in Kimberley ACCHSs each year

0 4 5 7 5 6 5 11 43

Other GPR posts in region (6 month FTE, private practice and hospitals)

2 6 4 2 2 3.5 1 3 23.5

Rural Clinical School funding - culmination of years of rural health lobbying, Max Kamien, Roger Strasser, Paul Worley etc.- Aboriginal health a stated priority, CAMDH and UWA

sees this as an opportunity!

NACCHO lobbying to get GP registrar salaries in ACCHSs paid by Dept of Health; and

Change to GP registrar education from RACGP to GPET results in innovation funding

Pharmacy Academics in University Departments of Rural Health (PAUDRH) initiative

Policy changes leading to opportunities

How is the education integrated?

Two way teaching - AHWs and medical students / RMOs / GP Registrars / Pharmacy students - formal and in clinic

Registrars supervise and teach PGPPP doctors and students

Registrars, PGPPP and students learn together at workshops, clinical meetings

Students return as PGPPP doctors, PGPPP return as GP registrars, GP registrars stay on as GPs and as educators

3 of the 6 people paid with fractional RCS appointments this year were former Kimberley GP registrars)

Why is the education integrated?

We want our workforce to work in teams and behave culturally appropriately

Our AHWs need a variety of input and benefit from medical student and junior doctor teaching

Teaching AHWs is very useful for the medical people when working with patients and with AHWs

Everyone enjoys it more!

Not enough resources to do it any other way!

Why the successes in the Kimberley?

Aboriginal health is most of the work in the region - forcing at least some focus on Aboriginal health

Remote and interesting to people from elsewhere – both the location and the diseases

Committed people: Puggy Hunter, Henry Councillor, Ian Wronski, Maggie Grant, Richard Murray, DeeDee Cox and many more

How do we get this to happen elsewhere?

KAMSC:• Organisational commitment to training our

own workforce• Lobbying for policy change• Taking advantage of opportunities that arise• Luck?Elsewhere - Policy needs to be much more

encouraging for ACCHS / coercive of universities

Funding attached to meaningful targets!

Meaningful targets?

Medical School funding tied to Aboriginal health (learn from rural health lobby)

All students must do at least 4 weeks in an ACCHS during their medical training (4 of 80+ clinical weeks is only 5%) cut funding to Universities which do less.

Assessment in Aboriginal health - local Aboriginal health organisations and AIDA sign off on assessment quality and quantity (and funded to do so)

Additional funding for ACCHSs and Universities that do more!

KAMSC partners

TIP # 5:

Don’t forget to get out and about……