"I have learnt ... a different way of looking at people's health": an evaluation of a prevocational medical training program in public health medicine and primary health care in remote Australia

Audit tools for culturally safe and responsive healthcare practices with Aboriginal and Torres Strait Islander people: a scoping review

Aboriginal and Torres Strait Islander people in Australia face disparities in accessing culturally safe and appropriate health services. While current cultural safety and responsiveness frameworks set standards for improving healthcare practices, ensuring accountability and sustainability of changes, necessitates robust mechanisms for auditing and monitoring progress. This study examined existing cultural safety audit tools, and facilitators and barriers to implementation, in the context of providing culturally safe and responsive healthcare services with Aboriginal and Torres Strait Islander people. This will assist organisations, interested in developing tools, to assess culturally responsive practice. A scoping review was undertaken using Medline, Scopus, CINAHL, Informit and PsychInfo databases. Articles were included if they described an audit tool used for healthcare practices with Aboriginal and Torres Strait Islander people. Selected tools were evaluated based on alignment with the six capabilities of the Indigenous Allied Health Australia (IAHA) Cultural Responsiveness in Action Framework. Implementation barriers and facilitators were identified. 15 papers were included. Audit tools varied in length, terminology, domains assessed and whether they had been validated or evaluated. Seven papers reported strong reliability and validity of the tools, and one reported tool evaluation. Implementation facilitators included: tool comprehensiveness and structure; effective communication; clear organisational responsibility for implementation; commitment to prioritising cultural competence; and established accountability mechanisms. Barriers included: the tool being time-consuming and inflexible; responsibility for implementation falling on a small team or single staff member; deprioritising tool use; and lack of accountability for implementation. Two of the six IAHA capabilities (respect for the centrality of cultures and inclusive engagement) were strongly reflected in the tools. The limited tool evaluation highlights the need for further research to determine implementation effectiveness and sustainability. Action-oriented tools, which comprehensively reflect all cultural responsiveness capabilities, are lacking and further research is needed to progress meaningful change within the healthcare system.

Health Sciences cultural safety education in Australia, Canada, New Zealand, and the United States: a literature review

OBJECTIVES

To review the research literature on cultural safety education within post-secondary health science programs.

METHODS

We conducted health and social science database searches from 1996-2016, using combined keywords: cultural competence or safety; teaching or curriculum; universities, polytechnics or professional programs; and Aboriginal or Indigenous. In dyads, authors selected, and reviewed studies independently followed by discussion and consensus to identify thematic linkages of major findings.

RESULTS

A total of 1583 abstracts and 122 full-text articles were reviewed with 40 selected for final inclusion. Publications from Australia, Canada, New Zealand and the United States described curriculum development and delivery. A variety of evaluation approaches were used including anecdotal reports, focus groups, interviews, course evaluations, reflective journals, pre-post surveys, critical reflective papers, and exam questions. Duration and depth of curricular exposure ranged from one day to integration across a six-year program.  Changes in student knowledge, attitude, self-confidence, and behaviour when working with Indigenous populations were reported. Cultural safety education and application to practice were shown to be linked to improved relationships, healthier outcomes, and increased number of Indigenous people entering health education programs and graduates interested in working in diverse communities.

CONCLUSIONS

This review provides a summary of multidisciplinary didactic and experiential instructional approaches to cultural safety education and the impact on students, educators and Indigenous people.  Institutional support, strategic planning and cultural safety curriculum policy within post-secondary settings and community engagement are imperative for positive student experiences, advocacy, and actions toward health equity and improved health for Indigenous people and communities.

Transformative effects of Aboriginal health placements for medical, nursing, and allied health students: A systematic review

The aim of the present systematic review was to investigate whether placements in Aboriginal health affect the self-perceived skill in working in Aboriginal health settings and career aspirations of health students, and in particular, aspects of the placement that had the greatest impact. The Embase, Cinahl, ProQuest, Scopus, Informit, Ovid MEDLINE, PsychINFO, and PubMed databases were searched in April/May 2016. Placements of at least 1 week duration in an Aboriginal health setting involving Australian students of medical, nursing, dentistry, or allied health disciplines, with outcomes relating to changes in students' knowledge, attitudes, and/or career aspirations, were included. The search retrieved 1351 papers. Fourteen studies were eligible for inclusion in this review. Narrative synthesis found that work placements in Aboriginal health increased understanding and awareness of Aboriginal culture, promoted deeper understanding of Aboriginal health determinant complexity, increased awareness of everyday racism toward Aboriginal Australians, and enhanced desire to work in Aboriginal health. There is a need for improved teaching and learning scholarship to understand whether placements improve students' skill working with Aboriginal people in health care or increase the likelihood of future employment in these settings.

Prevocational exposure to public health in the Kimberley: a pathway to rural, remote and public health practice

OBJECTIVE

To evaluate the Kimberley Population Health Unit (KPHU) prevocational public health placement in terms of its contribution to resident medical officers' (RMOs') knowledge, skills, career path and aspirations.

DESIGN

All RMOs who had completed a public health placement at the KPHU (n=27) during 2001-2012 were invited to complete an online survey in September 2012.

SETTING

The KPHU, based in Broome, provides population health services to the Kimberley region, far north Western Australia.

MAIN OUTCOME MEASURES

The extent to which RMOs perceived the development of public health skills and knowledge during the placement, and the degree to which RMOs believe this placement influenced future career pathways and their current practice.

RESULTS

Twenty-three RMOs (85%) completed the survey. Sixty per cent are currently working in general practice or public health medicine; of these, 43% have returned to the Kimberley. Over 70% reported that the placement developed their knowledge of public health and Aboriginal health to a 'great' or 'very great' extent. Sixty-one per cent felt that their placement influenced their future desire to work in public health 'a lot' or 'a great extent'.

CONCLUSION

This placement provides a unique opportunity for RMOs to undertake public health and Aboriginal health work in a remote setting. Given the increasing demand for prevocational placements, the value of imparting sound public health knowledge to the next generation of doctors and the urgent need to recruit and retain rural doctors, this placement provides a potential model that could be expanded to other locations.

Rural general practice placements: alignment with the Australian Curriculum Framework for Junior Doctors

OBJECTIVES

To review the available literature regarding skills and competencies gained by junior doctors in rural and regional general practice placements and their alignment with the Australian Curriculum Framework for Junior Doctors (ACFJD).

STUDY DESIGN

A comprehensive literature review using a three-phase process. Articles were initially identified from database searches in OvidSP and Scopus. Additional information was obtained after a hand search of contents pages from relevant journals and from reports, conference abstracts and grey literature. Documented skills and procedures were mapped against the competencies from the ACFJD.

DATA SOURCES

We analysed 36 relevant articles written in English and published during 1997-2011. Articles referring to learning outcomes for junior doctors training with rural general practitioners were included.

DATA SYNTHESIS

Evidence was available of the advantages of junior doctor rural general practice placements in gaining advanced skills in the areas of communication and professionalism, as well as developing autonomy in clinical management and decision making. Less evidence was available regarding exposure to particular clinical conditions and development of specific clinical skills.

CONCLUSION

Rural and regional general practice placements for junior doctors are likely to comply with the ACFJD requirements and, further, provide excellent learning opportunities in several domains of the curriculum. However, there was little research published confirming learning outcomes for junior doctors in rural general practice settings.

A Canadian survey of postgraduate education in Aboriginal women's health in obstetrics and gynaecology

OBJECTIVE

To assess Canadian obstetrics and gynaecology residents' knowledge of and experience in Indigenous women's health (IWH), including a self-assessment of competency, and to assess the ability of residency program directors to provide a curriculum in IWH and to assess the resources available to support this initiative.

METHODS

Surveys for residents and for program directors were distributed to all accredited obstetrics and gynaecology residency programs in Canada. The resident survey consisted of 20 multiple choice questions in four key areas: general knowledge regarding Indigenous peoples in Canada; the impact of the residential school system; clinical experience in IWH; and a self-assessment of competency in IWH. The program director survey included an assessment of the content of the curriculum in IWH and of the resources available to support this curriculum.

RESULTS

Residents have little background knowledge of IWH and the determinants of health, and are aware of their knowledge gap. Residents are interested in IWH and recognize the importance of IWH training for their future practice. Program directors support the development of an IWH curriculum, but they lack the resources to provide a comprehensive IWH curriculum and would benefit from having a standardized curriculum available.

CONCLUSION

A nationwide curriculum initiative may be an effective way to facilitate the provision of education in IWH while decreasing the need for resources in individual programs.

Indigenous cultural training for health workers in Australia

PURPOSE

Culturally inappropriate health services contribute to persistent health inequalities. This article reviews approaches to indigenous cultural training for health workers and assesses how effectively they have been translated into training programmes within Australia.

DATA SOURCES

CINAHL PLUS, MEDLINE, Wiley InterScience, ATSIHealth and ProQuest.

STUDY SELECTION

The review focuses on the conceptual and empirical literature on indigenous cultural training for health workers within selected settler-colonial countries, together with published evaluations of such training programmes in Australia. Data extraction Information on conceptual models underpinning training was extracted descriptively. Details of authors, year, area of investigation, participant group, evaluation method and relevant findings were extracted from published evaluations.

RESULTS OF DATA SYNTHESIS

Six models relevant to cultural training were located and organized into a conceptual schema ('cultural competence, transcultural care, cultural safety, cultural awareness, cultural security and cultural respect'). Indigenous cultural training in Australia is most commonly based on a 'cultural awareness' model. Nine published evaluations of Australian indigenous cultural training programmes for health workers were located. Of the three studies that assessed change at multiple points in time, two found positive changes. However, the only study to include a control group found no effect.

CONCLUSION

This review shows that the evidence for the effectiveness of indigenous cultural training programmes in Australia is poor. Critiques of cultural training from indigenous and non-indigenous scholars suggest that a 'cultural safety' model may offer the most potential to improve the effectiveness of health services for indigenous Australians.