Shaun Ewen

Medical schools as agents of change: socially accountable medical education

Medical education reform can make an important contribution to the future health care of populations. Social accountability in medical education was defined by the World Health Organization in 1995, and an international movement for change is gathering momentum. Priority community needs are generally not well reflected in existing medical curricula. Medical schools have often been concerned more with prestige, research competitiveness and training doctors for narrow specialist careers in urban areas. Orthodoxies in medical education have been challenged where the gap between a communitys health care needs and the availability of doctors has been greatest — notably in rural areas and, in Australia, in Aboriginal communities. At a time of growing crisis in health care systems, the need to focus on addressing health inequalities and delivering effective, affordable, people‐centred health care is more important than ever. While change can be enabled with policy levers, such as funding tied to achieving equity outcomes and systems of accreditation, medical schools and students themselves can lead the transformation agenda. An international movement for change and coalitions of medical schools with an interest in socially accountable medical education provide a “community of practice” that can drive change from within.

Do indigenous health curricula in health science education reduce disparities in health care outcomes

Objective: To undertake a systematic literature review to determine the scope, rationales, and evaluation foci of indigenous health curricula included in university‐based professional training of health care service providers.

What helps and hinders indigenous student success in higher education health programmes: a qualitative study using the Critical Incident Technique

Tertiary institutions aim to provide high quality teaching and learning that meet the academic needs for an increasingly diverse student body including indigenous students. Tātou Tātou is a qualitative research project utilising Kaupapa Ma¯ori research methodology and the Critical Incident Technique interview method to investigate the teaching and learning practices that help or hinder Ma¯ori student success in non-lecture settings within undergraduate health programmes at the University of Auckland. Forty-one interviews were completed from medicine, health sciences, nursing and pharmacy. A total of 1346 critical incidents were identified with 67% helping and 33% hindering Ma¯ori student success. Thirteen sub-themes were grouped into three overarching themes representing potential areas of focus for tertiary institutional undergraduate health programme development: Māori student support services, undergraduate programme, and Ma¯ori student whanaungatanga. Academic success for indigenous students requires multi-faceted, inclusive, culturally responsive and engaging teaching and learning approaches delivered by educators and student support staff.

Revealing the (in)competency of “cultural competency” in medical education

There are multiple factors that influence the quality of health and the health care experience of Aboriginal patients. Some of these factors include health professionals’ clinical decision-making and miscommunication between doctor and patient. A more “culturally competent” health workforce is a recommended strategy in addressing the extensively documented health disparities between Australias Aboriginal and non-Aboriginal peoples. Culture, its importance in, and connection to health, is being increasingly explored in medical curricula with the expectation of improved health outcomes. This literature review on cultural competency in medical curricula reveals an emerging awareness of the paucity of data showing evidence of positive health outcomes for Aboriginal patients of “culturally competent” medical professionals. This highlights the need for there to be evidence of more than just practitioner satisfaction but also of meaningful shifts in health outcomes for Aboriginal patients of a more culturally knowledgeable medical profession.

The use of the International Classification of Functioning, Disability and Health to understand the health and functioning experiences of people with chronic conditions from the person perspective: a systematic review

Abstract Purpose: This systematic review examines the literature to identify the context and extent of implementation of the International Classification of Functioning, Disability and Health (ICF) model to understand the experience of health and functioning in persons with chronic conditions from the person perspective. Method: The literature search was conducted through five electronic databases between 2001 and December 2012. Reference lists of included papers were also searched. Articles in which the ICF was used to understand the health and functioning experience of adults with chronic conditions from the person-perspective were included. Data were extracted and analysed to identify the year of publication, geographical location, health condition, context of ICF use, authors’ remarks and identified limitations of the ICF. Results: Thirty-seven qualitative and mixed-methods studies were included representing 18 countries and a range of chronic conditions. The ICF was found to be used to elicit and analyse people’s narratives, with the majority of studies reporting that the ICF provides a comprehensive analysis of experiences and needs from the person perspective. Some limitations to its use and the need to classify the “personal factors” component were reported. Conclusion: The ICF has been used to provide a comprehensive understanding of health and functioning in persons with chronic conditions from the person perspective, although there are currently relatively few studies which have used the ICF in this context. Limitations regarding its use were reported which should be considered by users of the model and during its revision process. Implications for Rehabilitation The ICF encourages a bio-psycho-social and person-centred approach to healthcare and may provide a useful tool for guiding clinical assessment and encouraging clinicians to consider the multitude of factors which impact health, which may result in more specific and individualised treatment targeted at individual needs. Using a common framework that can be understood across health disciplines may enhance interdisciplinary communication and collaboration, improving health care delivery. The ICF may be used to compare perspectives of individuals and their health professionals and to identify people’s needs that are not adequately being addressed, which may have significant implications for improving healthcare provided and overall health outcomes.

The use of the international classification of functioning, disability and health (ICF) in indigenous healthcare: a systematic literature review

IntroductionThe International Classification of Functioning, Disability and Health (ICF) was endorsed by the World Health Organisation (WHO) in 2001 to obtain a comprehensive perspective of health and functioning of individuals and groups. Health disparities exist between Indigenous and non-Indigenous Australians and there is a need to understand the health experiences of Indigenous communities from Indigenous Australian’s perspectives in order to develop and implement culturally appropriate and effective intervention strategies to improve Indigenous health. This systematic review examines the literature to identify the extent and context of use of the ICF in Indigenous healthcare, to provide the foundation on which to consider its potential use for understanding the health experiences of Indigenous communities from their perspective.MethodsThe search was conducted between May and June 2012 of five scientific and medical electronic databases: MEDLINE, Web of Science, CINAHL, Academic Search Complete and PsychInfo and six Indigenous-specific databases: AIATSIS, APAIS-health, ATSI-health, health and society, MAIS-ATSIS and RURAL. Reference lists of included papers were also searched. Articles which applied the ICF within an Indigenous context were selected. Quantitative and qualitative data were extracted and analysed by two independent reviewers. Agreement was reached by consensus.ResultsFive articles met the inclusion criteria however two of the articles were not exclusively in an Indigenous context. One article applied the ICF in the context of understanding the health experience and priorities of Indigenous people and a second study had a similar focus but used the revised version of the International Classification of Impairments, Disability and Handicap (ICIDH-2), the predecessor to the ICF. Four of the five papers involved Indigenous Australians, and one of the paper’s participants were Indigenous (First Nation) Canadians.ConclusionLiterature referring to the use of the ICF with Indigenous populations is limited. The ICF has the potential to help understand the health and functioning experience of Indigenous persons from their perspective. Further research is required to determine if the ICF is a culturally appropriate tool and whether it is able to capture the Indigenous health experience or whether modification of the framework is necessary for use with this population.RésuméIntroductionLa Classification Internationale du Fonctionnement, de l’Incapacité et de la Santé (ICF) a été apprové par l’Organisation Mondiale de la Santé (OMS) en 2001 pour obtenir une perspective complète de la santé et du fonctionnement des individus et des groupes. Des disparités de santé existent entre les Australiens indigènes et non-indigènes et il y a un grand besoin de comprendre les états de santé des communautés indigènes vus de leur propre perspective afin de développer et mettre en application des stratégies d’intervention culturellement appropriées et efficaces pour améliorer leur santé. Cette révision systématique vérifie toute documentation pour identifier l’ampleur et le contexte de l’utilisation de l’ICF dans les soins des Indigènes permettant ainsi de considérer son utilisation potentielle pour comprendre les expériences de santé des communautés indigènes vues de leur propre perspective.MéthodesLa recherche a été accomplie entre mai et novembre 2012 à partir de cinq bases de données électroniques scientifiques et médicales: MEDLINE, Web of Science, CINAHL, Academic Search Complete, PsychInfo et six bases de données spécifiquement indigènes: AIATSIS, APAIS-health, ATSI-health, health and society, MAIS-ATSIS et RURAL. Les listes de références des documents inclus ont été également examinées. Les articles qui s’appliquaient à l’ICF dans le contexte indigène ont été sélectionnés. Des données quantitatives et qualitatives ont été extraites et analysées par deux critiques indépendants et les désaccords ont été résolus par consensus.RésultatsCinq articles ont bien répondu aux critères d’inclusion, bien que deux des articles n’aient pas fait exclusivement partie d’un contexte indigène. L’un des articles a appliqué l’ICF pour comprendre les expériences et les priorités de santé des Indigènes et une deuxième étude a fait de même mais a employé une nouvelle version de la Classification Internationale de l’ Infirmité, l’Incapacité et le Handicap (ICIDH-2), le prédécesseur de l’ICF. Tous les documents concernaient les Indigènes australiens à l’exception d’un dont les participants étaient des Indigènes (Premières Nations) canadiens.ConclusionLa documentation se rapportant à l’utilisation de l’ICF avec des populations indigènes est limitée. L’ICF a le potentiel d’aider à comprendre les expériences de santé et le fonctionnement des Indigènes vus de leur propre perspective. Davantage de recherche est essentielle pour déterminer si l’ICF est culturellement appropriée et peut capturer les expériences de santé des Indigènes ou si une modification de cadre est nécessaire pour son utilisation avec cette population.

Innovation in Indigenous Health and Medical Education: The Leaders in Indigenous Medical Education (LIME) Network as a Community of Practice

Problem: The Leaders in Indigenous Medical Education (LIME) Network aims to improve the quality and effectiveness of Indigenous health in medical education as well as best practice in the recruitment, retention, and graduation of Indigenous medical students. Intervention: In this article we explore the utility of Etienne Wengers “communities of practice” (CoP) concept in providing a theoretical framework to better understand the LIME Network as a form of social infrastructure to further knowledge and innovation in this important area of health care education reform. Context: The Network operates across all medical schools in Australia and New Zealand. Outcome: Utilizing a model of evaluation of communities of practice developed by Fung-Kee-Fung et al., we seek to analyze the outcomes of the LIME Network as a CoP and assess its approach and contribution to improving the implementation of Indigenous health in the medical curriculum and the graduation of Indigenous medical students. Lessons Learned: By reflecting on the Network through a community of practice lens, this article highlights the synthesis between the LIME Network and Wengers theory and provides a framework with which to measure Network outputs. It also posits an opportunity to better capture the impact of Network activities into the future to ensure that it remains a relevant and sustainable entity.

Identifying pedagogy and teaching strategies for achieving nationally prescribed learning outcomes

ABSTRACT With the globalisation of university education, national frameworks are commonly used to prescribe standardised learning outcomes and achieve accountability. However, these frameworks are generally not accompanied by guiding pedagogy to support academics in adjusting their teaching practices to achieve the set outcomes. This paper reports the results of a scoping review of health science literature aimed at identifying pedagogy and teaching strategies relevant to achieve the learning outcomes specified by the Australian Qualifications Framework at a masters degree level. Eight practical teaching messages emerged from the review and three broad pedagogical trends were identified: the need to use authentic disciplinary-based learning activities; ensure that students are able to discover different perspectives about future practice and bring student reflection about their own knowledge into curricula. More critically, the review highlights that academics attempting to translate national learning outcome frameworks into their teaching practices face a complex and time-consuming task which may involve searching beyond their own disciplinary focus to identify practical teaching strategies to meet prescribed learning outcomes.

Improving access to primary mental healthcare for Indigenous Australians

Objective: To examine the uptake, population reach and outcomes of primary mental healthcare services provided to Indigenous Australians via the Access to Allied Psychological Services (ATAPS) program between 2003 and 2013, with particular reference to enhanced Indigenous ATAPS services introduced from 2010. Method: Utilising ATAPS program data from a national minimum data set and comparative population data, we conducted descriptive analyses, regression analyses and t-tests to examine the uptake of ATAPS services, provider agency level predictors of service reach, and preliminary outcome data on consumer level outcomes. Results: Between 2003 and 2013, 15,450 Indigenous client referrals were made that resulted in 55,134 ATAPS sessions. National Indigenous service volume more than doubled between 2010 and 2012, following the introduction of enhanced Indigenous ATAPS services. Non-Indigenous ATAPS service volume of primary care agencies was uniquely predictive of Indigenous service reach. Preliminary analysis of limited consumer outcome data indicated positive treatment gains and the need to enhance future outcome data collection. Conclusions: Concerted national efforts to enhance mainstream primary mental healthcare programs can result in significant gains in access to mental healthcare for Indigenous populations.

Communication in Indigenous healthcare: extending the discourse into the physiotherapy domain

Considering the high mortality andmorbidity associated with chronic conditions amongst Indige-nous communities, it is essential to provide Indigenous Austra-lians access to equitable healthcare. Physiotherapists are wellpositioned to play an important role in preventing and managingmany health conditions that are prevalent amongst IndigenousAustralians.TheAustralianPhysiotherapyAssociation(APA)hasaPosition Statement on Indigenous Health