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Making a differenceMaking a difference
Changing the health workforce
David Paul, Helen Milroy & Paula Edgill
Center for Aboriginal Medical & Dental Health
UWA
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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
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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
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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
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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
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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)
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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)
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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)
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Achieving changeAchieving change
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Drivers for changeDrivers for change
Culturally secure health workforceSafer learning environmentSafer working environmentMore Aboriginal people in the health
workforce (not just as doctors!)
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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
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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
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Barriers to changeBarriers to change
Small team Institutional racismMulticultural agendasPerceptions of special treatmentReluctance amongst other academicsStudent resistancesFighting from the marginsResourcing
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Where to from here?Where to from here?
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Next stepsNext steps
Embedding gains Moving from relationship to structural
Developing outcomes and content in: Dentistry Podiatry Health Science
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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
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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