Examining Students

1
Examining Students Experiences of Indigenous
Health within the Monash MBBS

• Lana Prout
• MBBS (Hons)BMedSc (Hons)

2
Introduction
Indigenous people, encompassing those of both
Aboriginal and Torres Strait Islander origin,
remain the least healthy group of people in
Australia, with an average life expectancy 17
years lower than the national average (ABS,
2007). The reasons for this are complex and
numerous. The achievement of substantial
improvements in Indigenous health will depend on
both health and non-health sectors working
together with Indigenous leaders and communities.
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Introduction
The education of future medical practitioners
must take into consideration this current
disparity of health status between Indigenous and
non-Indigenous Australians and ensure that
medical students are taught how to facilitate
culturally-appropriate healthcare in order to
assist the improvement of Indigenous health
outcomes.
4
Background

• CDAMS Indigenous Health Curriculum Development
  Project (2003)
• CDAMS Indigenous Health Curriculum Framework
  (2004)
• AMC Accreditation Standards Endorsement of
  IHCF(2004)
• AMC Re-endorsement (2007)
• University Curriculum developments
• University of Newcastle
• University of Western Australia
• James Cook University

5
Structure of the Project

• Project Outline
• Literature Review
• Ethics Approval
• Data Gathering
• Data Analysis
• Thesis Writing
• Recommendations

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Rationale for the Project

• Identified gap in the literature
• Limited investigation into students experiences
  of Indigenous health curricula
• Significance of CDAMS Indigenous Health
  Curriculum Framework implementation
• Recommendations from Government bodies for
  inclusion of appropriate Aboriginal health
  teachings in medical courses

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Aims of the Project

• To examine a cohort of Monash medical students
  experiences of the Indigenous health curriculum
  of the Monash MBBS course through the use of
  semi-structured interviews with current medical
  students

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Aims of the Project

• The project intended to assess
• What exposure students have had
• Their understanding of the rationale behind
  including Indigenous health within the MBBS
  curriculum
• Their interpretation of the meaning of Indigenous
  health teachings in the context of the broader
  MBBS course
• Compare students experiences with audited
  Indigenous health curricula CDAMS IHCF
• Provide feedback to Faculty

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Literature Review

• Kamien,1975, Education in community medicine with
  an emphasis on the health of an Aboriginal
  community a pilot project
• Kaufman, 1984, Medical students and Aborigines
  can prejudice be reduced?
• Copeman, 1989, Medical students, Aborigines and
  migrants evaluation of a teaching programme
• Jamrozik, 1995, Going bush helping medical
  students learn from Aboriginal people
• Garvey Hazell, 1997, Developing rapport
  Aboriginal camps for medical students
• Rasmussen, 2001, Towards reconciliation in
  Aboriginal health initiatives for teaching
  medical students about Aboriginal issues
• Paul, Carr Milroy, 2006, Making a difference
  the early impact of an Aboriginal health
  undergraduate medical curriculum

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Literature Review

• International
• New Zealand (Otago University)
• Canada
• United States of America
• Phillips, 2004, CDAMS Indigenous Health
  Curriculum Framework
• Phillips, 2004, CDAMS Indigenous Health
  Curriculum Development Project National Audit
  and Consultations Report
• Wilson, 2006, CDAMS Indigenous Health Curriculum
  Review Mapping exercise examining Indigenous
  health content in the MBBS

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Methodology

• Qualitative data
• Semi-structured interviews
• Criterion sampling
• Active clinical medical student
• Previous exposure to Indigenous health curriculum
• Based in Gippsland during 2007
• Volunteer sampling

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Semi-Structured Interviews

• Audio-taped
• Themes
• Exposure to Indigenous Health
• Understanding of the rationale behind inclusion
  of Indigenous Health within the MBBS
• Experience and meaning of Indigenous health in
  the context of the broader MBBS course

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Methodology Data Analysis

• Miles and Huberman Framework for Qualitative Data
  Analysis (1994)
• Data Reduction
• Editing
• Coding and memoing
• Identifying themes
• Conceptualising and explaining
• Data Display
• Drawing and Verifying conclusions
• Thematic analysis
• Inductive and Deductive

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Results Background Info

• 12 interviews
• Origin Rural (58), City (42)
• Year Level III (50), IV (50)
• Only 3 students had had significant prior contact
  with Indigenous people
• Year IVs reported more Indigenous health
  teachings

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Results
CDAMS Subject Area CDAMS Audit (2003) Monash Review(2006) Student Experience (2007)
History Y L Y L Y L
2. Culture, Self and Diversity Y FT Y L N
3. Indigenous Societies, Culture and Medicine Y FT Y FT Y FT, RS
4. Population Health Y L Y L Y L
5. Models of Health Service Delivery N N Y RS, SPC
6. Clinical Presentation of Disease Y PBL, O Y PBL, PV, SPT Y PBL, SPC
7. Communication Skills Y O, PV Y PV Y O, SPT N
8. Working with Indigenous Peoples Ethics, Protocols and Research N N N
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Key Themes

• Integration
• Temporality
• Clinical relevance
• Locality
• City-Neglect
• Delivery
• Authenticity and Credibility
• Hidden curriculum

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Student Reported Barriers

• Poor integration of Indigenous health across all
  themes of the MBBS course
• Teaching Indigenous health only in a rural
  context
• Providing teaching focused on the pre-clinical
  years
• Locating a lot of Indigenous health teaching only
  within electives
• Dictating teaching methods
• Authenticity of the teacher (in some cases)

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Student Reported Facilitators

• Integrating Indigenous health across all themes
  of the course
• Interactive teaching methods
• Using teaching staff who have experience and
  passion regarding Indigenous health
• Appropriate involvement of Indigenous people
  including providing adequate briefing
• Providing opportunities for clinical experience
  in Indigenous health
• Offering electives, on top of the core
  curriculum, for students with demonstrated
  interest in Indigenous health

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Recommendations

• Undergo further curriculum evaluation and
  development
• Expand Indigenous health teachings to ensure all
  students are able to satisfy IHCF standards
• Ensure adequate horizontal and vertical
  integration
• Re-emphasise the clinical relevance of Indigenous
  health
• Introduce tutorial-based, interactive learning
  opportunities
• Ensure that both rural and urban perspectives of
  Indigenous health are taught

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Recommendations

• Use teaching staff with experience in and
  demonstrated passion for Indigenous health
• Increase the representation of Indigenous people
  within the Faculty
• Involve Indigenous people appropriately ensuring
  adequate briefing
• Improve the training for tutors (e.g. PCL)
• Offer additional learning opportunities for
  students with a demonstrated interest

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Limitations

• Small participant group
• Only 2 year levels
• Effect of recall bias
• Rural Clinical School students
• Relationship between participants and researcher

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Areas for Further Research

• Larger sample size
• Longitudinal tracking
• Undergraduate
• Post-graduate
• Impact of outside exposure
• Influence of prior exposure to Indigenous people
• Effect of curriculum on student attitudes
  regarding Indigenous issues overall

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Conclusion

• Unfavourable comparison between
• Monash vs. CDAMS IHCF
• Students vs. Documented curriculum
• Factors deemed by students to influence their
  learning in Indigenous health
• Need for additional development and ongoing
  evaluation of curriculum
• Further research necessary

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References

• Australian Bureau of Statistics (2007). Year Book
  Australia 2007. Retrieved 2 June 2007 from
  http//www.abs.gov.au/Ausstats/abs_at_.nsf/Latestprod
  ucts/1301.0Main20Features12007?opendocumenttabna
  meSummaryprodno1301.0issue2007numview
• Phillips, G.L. (2004). CDAMS Indigenous Health
  Curriculum Framework. Melbourne VicHealth Koori
  Health Research and Community Development Unit,
  University of Melbourne
• Green, J. and Thorogood, N. (2004). Qualitative
  Methods for Health Research, Chapter 8, London,
  Sage.
• Liamputtong, P. and Ezzy, D. (2005). Qualitative
  Research Methods, Chapter 12, Melbourne, Oxford.
• Minichiello, V. et al (1995). In-Depth
  Interviewing, Melbourne, Longman.
• Punch, K. (2005). Analysis of Qualitative Data,
  Chapter 10, Sage electronic resource Accessed
  16/July/07 via Monash University Digitised
  Collection
• Snyder, B. (1971). The Hidden Curriculum, New
  York, Knopf.
• Wolcott, H.F. (1994). Transforming Qualitative
  Data Description, Analysis and Interpretation,
  Chapter 4, Thousand Oaks CA, Sage. Accessed
  16/July/07 from www.ehr.nsf.gov/EHR/REC/pubs/NSF9
  7-153/CHAP_4.HTM