Making a differenceMaking a difference

Changing the health workforce

David Paul, Helen Milroy & Paula Edgill

Center for Aboriginal Medical & Dental Health

UWA

Making a difference …Making a difference …

Creating change in the undergraduate medical curriculum Creating content Graduate outcomes in Aboriginal health Year level outcomes Unit level outcomes

From small beginnings …From small beginnings …

1984 - first formal ongoing content - Yr 6 1996 - 3hrs maximum over 6 yrs2000 - “new” curriculum commenced 2003 - year level outcomes2005 - completed curriculum implementation2006 - Aboriginal Health Specialisation in MBBS2007 - 40hrs core curriculum over 6yrs

Over 150hrs (all the options) >560 hours of teaching

StructureStructure

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

Structure …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

Outcomes / evaluationsOutcomes / evaluations

25 point evaluation questionnaire Self reporting Yr 6 since 2003 Substantial shifts documented

Shared tool with other health programs (U/G & P/G)

Curriculum evaluationCurriculum 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)

Curriculum evaluation …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)

Achieving changeAchieving change

Drivers for changeDrivers for change

Culturally secure health workforceSafer learning environmentSafer working environmentMore Aboriginal people in the health

workforce (not just as doctors!)

Facilitating factorsFacilitating factors

Support from executiveCo-location and strong partnership with School

of Indigenous StudiesCore understandings from CAMDH - Indigenous

driven and ledDedicated team

3 medical graduates (2 Indigenous)Faculty wide briefLoci of support within faculty

Partnership and processPartnership and process

Strategies for implementation New curriculum for whole course Built on existing partnerships Developed new partnerships

Evaluation outcomes Added strength for future changes

Barriers to changeBarriers to change

Small team Institutional racismMulticultural agendasPerceptions of special treatmentReluctance amongst other academicsStudent resistancesFighting from the marginsResourcing

Where to from here?Where to from here?

Next stepsNext steps

Embedding gains Moving from relationship to structural

Developing outcomes and content in: Dentistry Podiatry Health Science

Current concernsCurrent concerns

Shifting ground at a faculty levelMaintaining the gainsKeeping up the energy to revisit the same

old resistances as new players enter the faculty

Sustainability

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