Teaching and assessment of clinical Hauora Māori in 4 th year medicine at the FMHS, Auckland

1. Teaching and assessment of clinical Hauora Māori in 4th year medicine at the FMHS, Auckland Dr Sue Crengle 3rd December 2009

2. Medical programme at Auckland FMHS • Overall 6 year programme • year 1 – health science foundation year • MBChB years 2 & 3 – fundamentals of clinical practice (Phase 1) • MBChB years 4 & 5 – clinical practice in context (Phase 2) • MBChB year 6 – preparation for the workforce

3. Māori health teaching • 4 core domains in medical curriculum • Hauora Māori domain • Integrated in learning and assessment across medical programme • Specific Māori health teaching in Year 2 and Year 4 • Other specific teaching/learning activities in courses in years 1 and 3, and during paeds in year 5 • Hauora Māori learning outcomes • 8 themes

4. Hauora Māori themes • Ethnicity and Demography • Epidemiology and Inequalities • Racism • Working with Māori patients, whānau and communities • Cultural competence • Self-reflection • Quality of care and clinical audit • Lifelong learning • Phase appropriate learning outcomes in each of these themes

5. 4th year Māori health learning outcomes Epidemiology and Inequalities • Demonstrate an awareness of current evidence relating to inequalities and Māori health Racism • Identify racist ideas in common discourse and provide appropriate responses

6. 4th year Māori health learning outcomes Working with Māori patients, whānau and communities • Describe approaches to working with Māori patients and whānau • Demonstrate a working knowledge of support services (e.g. Kaiatawhai, Māori providers) Cultural competence • Explain how the culture of health professionals and health systems can influence health care outcomes

7. 4th year Māori health learning outcomes Quality of care and clinical audit • Describe differences in quality of care for Māori and non-Māori in the New Zealand health system • Describe the basic process of clinical audit and explain why it is an important part of clinical practice

8. 4th year Māori health learning outcomes Self-reflection • Observe, describe and analyse clinical interactions (involving others) in terms of cultural competency Lifelong learning • Recognise the need for ongoing learning and professional development in Māori health

9. 4th year teaching and learning • 2 ½ days • Information about local iwi/marae, pōwhiri • Quality of care and clinical audit • Case study cardiovascular disease • Discourse, discrimination and its effects on health • Māori health services in hospital and community • Working with Māori patients and whānau • practitioners • Te Reo session

10. Assessment • (Clinical attachment assessment forms) • 4th year exam • 12 mark short answer question in end of year exam • Medical attachment – Māori case history

11. Exam question • Relatively straight forward • Question taken directly from course material (presentations, readings, course book)

12. Māori medical case history Case - history, examination, investigations with discussion • A culturally-appropriate management plan for the patient • Self-identified strengths and areas to improvement in communication and clinical skills when caring for a Māori patient • Provided with guidelines for writing the case and discussion

13. Māori medical case history - guidelines • Focus on culturally competent clinical management • Encourage student to think in a comprehensive way • E.g. multiple admissions - why? • ‘non-compliant’ – why? • Quality of care • Remember diversity • Sensitivity required • Self-reflection and/or observation of interactions • Includes a few ‘don’ts’!

14. Strengths and challenges – teaching and assessment • Hauora Māori curriculum domain BUT • early stages of implementation • Specific Māori health teaching BUT • Limited integration of Māori health teaching and learning elsewhere • Limited involvement of Māori health staff • Capacity / competence of non-Māori to teach Māori health • Quality control??

15. Strengths and challenges - teaching and assessment • Increasing class sizes • Innovative teaching / learning methods and environments

16. Strengths and challenges - teaching and assessment • Fostering practice that • Is located in a contextual understanding • Incorporates more than the immediate presenting complaint e.g. multiple admissions, ‘compliance’, knowledge • Is clinically based • Avoids romanticism and is able to accommodate diversity • Meaningful self-reflection

17. Strengths and challenges - teaching and assessment • Standards based assessments • Beginning of year vs. end of year • But is the only general medicine run • Capability / willingness of non-Māori staff to assess Hauora Māori • Hauora Māori domain in clinical attachment assessment form • Māori case history • Capacity of Māori staff

18. Challenges – teaching and assessment • Students and non-Māori staff assimilating Māori health practice into every day work • Opportunities for other methods of assessment • AKO • e-based? • Virtual?

19. Summary • Overview of the teaching and assessment of Māori health in 4th year of medical programme • Outline of the strengths and challenges • A work in progress…