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Implementing the new Australian Medical Council
standards: The focus on Indigenous health
Professor Michael FieldChair,
Medical School Accreditation Committee, AMC
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AMC accreditation in brief
• Assesses and accredits basic & postgraduate medical education and training programs in Australia & New Zealand.– Assess against explicit standards developed
in collaboration with stakeholders
– Assess by peer review
– Results in a public report
– Mandatory for medical schools, voluntary for colleges
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Power of Accreditation
• Promotes regular self assessment
• Addresses stakeholder interests, e.g. choice of team members
• Team visit fosters exchange of ideas
• Reports highlight strengths AND challenges
• Covers issues other than students’ knowledge, e.g. student selection & support, relations between school and health services
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Accreditation Processes 1• AMC promulgates clear accreditation
standards: does not prescribe curricula, but supports diversity
• College/medical school completes self assessment
• AMC chooses Team (medical & non-medical)
• College/medical school produces submission organised around AMC accreditation standards
• Team meets, reviews documents, formulates questions, plans assessment
• AMC gathers additional information for Team
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An AMC Team
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Accreditation Processes 2
• Team site visits and meetings (1 -2 weeks)
• Team presents preliminary findings
• AMC invites feedback on the process
• Team writes report against accreditation standards
• Report reviewed by school/college, & AMC accreditation committee
• Council grants accreditation – range of options
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Indigenous health and the AMC standards
• 2000: Active engagement with a wide range of stakeholders, consumers, trainees, health professions
• Inconsistency - focus on Maori health during NZ visits but limited focus on Indigenous health in Australian visits
• Indigenous Health Curriculum Framework supported by the medical schools & adopted by AMC in 2004 Only such framework adopted by AMC
• 2005-06: AMC working parties review accreditation standards
• New standards approved by Council in July 2006 after stakeholder consultation
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Standards & Guidelines
• The standards– articulate the specific requirements
that Schools are required to meet
• The guidelines– reflect AMC’s understanding of best
practice– provide more detail about the areas
that need to be covered in addressing the standard
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Principles• Australia has special
responsibilities to Aboriginal and Torres Strait Islander people, and New Zealand to Maori, and these responsibilities should be reflected throughout the medical education process.
• Doctors work in a context in which the Indigenous peoples of Australia and New Zealand bear the burden of gross social, cultural and health inequity.
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Explicit Indigenous content 1• Educational expertise
– appropriate use of educational expertise, including the educational expertise of Indigenous people, in the development & management of the medical course
• Interaction with the health sector– School recognises the unique challenges
faced by Indigenous health services, and has effective partnerships with relevant local communities, organisations & individuals
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Explicit Indigenous content 2• Staff appointment, promotion and development
– employment practices are culturally inclusive
• Mission– mission addresses Indigenous peoples & their
health
• Curriculum structure, composition & duration– the course provides a comprehensive coverage of
Indigenous health (history, cultural development and health of Indigenous people)
• Ongoing monitoring– implementation of Indigenous Health Curriculum
Framework reviewed on a regular basis
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Explicit Indigenous content 3
• Student intake– clearly defined quotas for students
from under-represented groups, including Indigenous students (specific admission and recruitment processes)
• Student support– appropriate student support to cater
for the needs of students including social, cultural and personal needs
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Explicit Indigenous content 4
• Clinical teaching resources– provides all students with
experience of the provision of health care to Indigenous people in a range of settings and locations
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Implementation 1
• From January 2007, medical schools must describe their programs/processes and demonstrate their success. Will be assessed by AMC teams
• AMC/AIDA/MDANZ plan to evaluate new standards’ effectiveness.
• New questions for the assessment of overseas trained doctors.
• Promulgate AMC changes internationally
• In the future - Colleges?
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Implementation 2
• Changes at the AMC– team chairs & members briefed on
changes – culturally appropriate process and
guidelines – train teams to question school’s
statements and to measure success– expand the pool of trained Australian
Aboriginal & Torres Strait Islander team members and Maori team members
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Assessment tools
• AMC encourages self-reflection and critical analysis of performance & plans
• Identification of strengths, challenges & processes for addressing challenges
• Critical Reflection Tool – Schools can use as part of their self-
assessment– Consistent with AMC standards
• AMC Assessment– Standards used to ask specific questions and
gather data• Interviews with stakeholders – staff,
students, clinicians, community leaders
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S1 S2 S3 S4 S5 S6
<07 07 <07 07 <07 07 <07 07 <07 07 <07 07
Reference group na na Mission na na Curriculum development na na Curriculum content na na Employment strategy ? ? na ? na Placements na na Admissions na ? na Support unit na ? na
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Strengths
• Schools with an explicit Indigenous focus are, on the whole, building on existing achievements
• New schools report that they are addressing Indigenous health in curriculum development
• Most schools report including explicit Indigenous content in their curriculum
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Issues and areas needing consideration
• Robustness of Indigenous input– depth of reported input variable– needs to be formalised
• Clinical experience with Indigenous people– highly variable in quality, duration &
accessibility of opportunities
• Indigenous student recruitment– challenge of meeting quota
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Outcomes of Assessment
• AMC provides feedback via accreditation report
• Ongoing follow-up of outstanding issues:– Periodic reports– Explicit reporting requirements with
set timeframes– Follow-up visits– Limited accreditation
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Conclusion
• Incorporation of specific Indigenous standards has raised the awareness of the importance of addressing these issues for schools
• Schools appear committed to addressing Indigenous health needs in the curriculum
• Need time for longitudinal impacts to emerge
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Acknowledgements
• Johann Sheehan, AMC
• Theanne Walters, AMC
• AMC Team chairs and members
• Medical School deans