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Making a difference

Making a difference. Changing the health workforce David Paul, Helen Milroy & Paula Edgill Center for Aboriginal Medical & Dental Health UWA. Making a difference …. Creating change in the undergraduate medical curriculum Creating content Graduate outcomes in Aboriginal health

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Making a difference

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  1. Making a difference Changing the health workforce David Paul, Helen Milroy & Paula Edgill Center for Aboriginal Medical & Dental Health UWA

  2. Making a difference … • Creating change in the undergraduate medical curriculum • Creating content • Graduate outcomes in Aboriginal health • Year level outcomes • Unit level outcomes

  3. From small beginnings … • 1984 - first formal ongoing content - Yr 6 • 1996 - 3hrs maximum over 6 yrs • 2000 - “new” curriculum commenced • 2003 - year level outcomes • 2005 - completed curriculum implementation • 2006 - Aboriginal Health Specialisation in MBBS • 2007 - 40hrs core curriculum over 6yrs • Over 150hrs (all the options) • >560 hours of teaching

  4. Structure • Core: • Yr 1 - 3: lectures (x6), PBLs (x6), Tutors • Yr 4: Case report (x1) • Yr 5: Case report (x1), CBL (x2), Tutorials (x2), self directed • Yr 6: Seminar (x1), Rural GP placement

  5. Structure … • Options • Yr 2- 1 semester unit • Yr 3 - 2 semester units • Yr 4 - Research option • Yr 5 - Clinical options (4) • Yr 6 - Elective • Aboriginal health specialisation MBBS

  6. Outcomes / evaluations • 25 point evaluation questionnaire • Self reporting • Yr 6 since 2003 • Substantial shifts documented • Shared tool with other health programs (U/G & P/G)

  7. Curriculum evaluation • Ability to communicate appropriately with Aboriginal people: • 2003 - 29% (mean 3.0) • 2004 - 69% (mean 3.6) • 2005 - 60% (mean 3.8) • 2006 - 66% (mean 3.8)

  8. Curriculum evaluation … • Apply knowledge of Aboriginal Health to provide culturally secure health care: • 2003 - 14% (mean 2.6) • 2004 - 62% (mean 3.5) • 2005 - 61% (mean 3.8) • 2006 - 71% (mean 3.8)

  9. Achieving change

  10. Drivers for change • Culturally secure health workforce • Safer learning environment • Safer working environment • More Aboriginal people in the health workforce (not just as doctors!)

  11. Facilitating factors • Support from executive • Co-location and strong partnership with School of Indigenous Studies • Core understandings from CAMDH - Indigenous driven and led • Dedicated team • 3 medical graduates (2 Indigenous) • Faculty wide brief • Loci of support within faculty

  12. Partnership and process • Strategies for implementation • New curriculum for whole course • Built on existing partnerships • Developed new partnerships • Evaluation outcomes • Added strength for future changes

  13. Barriers to change • Small team • Institutional racism • Multicultural agendas • Perceptions of special treatment • Reluctance amongst other academics • Student resistances • Fighting from the margins • Resourcing

  14. Where to from here?

  15. Next steps • Embedding gains • Moving from relationship to structural • Developing outcomes and content in: • Dentistry • Podiatry • Health Science

  16. Current concerns • Shifting ground at a faculty level • Maintaining the gains • Keeping up the energy to revisit the same old resistances as new players enter the faculty • Sustainability

  17. The thing is, although passing anatomy, biochemistry, epidemiology, etc is what will get me through the medical course, it’s the ideas, knowledge and thought processes that I’ve gained from the Aboriginal Health unit that will stand me in great stead for many years to come, both as a doctor and simply as a member of Australian society ... Second year medical student May 2006

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