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

Dr Sue Crengle

3rd December 2009

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

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

Hauora Māori themes

1. Ethnicity and Demography2. Epidemiology and Inequalities3. Racism 4. Working with Māori patients, whānau and communities5. Cultural competence6. Self-reflection7. Quality of care and clinical audit8. Lifelong learning

• Phase appropriate learning outcomes in each of these themes

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

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

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

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

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

Assessment

• (Clinical attachment assessment forms)

• 4th year exam– 12 mark short answer question in end of year exam

• Medical attachment – Māori case history

Exam question

• Relatively straight forward• Question taken directly from course material

(presentations, readings, course book)

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

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’!

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??

Strengths and challenges - teaching and assessment

• Increasing class sizes

• Innovative teaching / learning methods and environments

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

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

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?

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…