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Ansell A. Five ways to get a grip on the need to include clinical placements in Indigenous settings. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:47-51. [PMID: 35875445 PMCID: PMC9297254 DOI: 10.36834/cmej.72878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Educational organizations that train medical professionals are intricately linked to the responsibility of creating culturally safe healthcare providers. However, prevailing inequities contribute to the continued oppression of Indigenous peoples, evidenced by inequitable access, treatment, and outcomes in the healthcare system. Despite an increasing awareness of how colonialist systems and the structures within them can contribute to health disparities, this awareness has not led to drastic improvements of health outcomes for Indigenous peoples. Many recently graduated health professionals will have likely encountered Indigenous peoples as a minority population within the larger, non-Indigenous context. Clinical placements in Indigenous settings may improve recruitment and retention of healthcare professionals in rural and remote settings, while helping educational institutions fulfill their social accountability missions. These placements may aid in the decolonization of care through reductions in bias and racism of medical professionals. Clinical placements in Indigenous settings may better prepare providers to navigate the dynamic challenges of the healthcare needs of Indigenous peoples safely and respectfully.
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Affiliation(s)
- Alexandra Ansell
- Faculty of Graduate Studies & Research, University of Alberta, Alberta, Canada
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Green E, Quilliam C, Sheepway L, Hays CA, Moore L, Rasiah RL, Bailie J, Howard C, Hyde S, Inyang I, Matthews K, Ferns J, Brown LJ, Jones S, Collett M. Identifying features of quality in rural placements for health students: scoping review. BMJ Open 2022; 12:e057074. [PMID: 35396299 PMCID: PMC8995951 DOI: 10.1136/bmjopen-2021-057074] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore and synthesise the evidence relating to features of quality in rural health student placements. DESIGN Scoping review. DATA SOURCES MEDLINE, CINAHL, Embase, ProQuest, Informit, Scopus, ERIC and several grey literature data sources (1 January 2005 to 13 October 2020). STUDY SELECTION The review included peer-reviewed and grey literature from Organisation for Economic Co-operation and Development listed countries that focused on quality of health student placements in regional, rural and remote areas. DATA EXTRACTION Data were extracted regarding the methodological and design characteristics of each data source, and the features suggested to contribute to student placement quality under five categories based on a work-integrated learning framework. RESULTS Of 2866 resulting papers, 101 were included for data charting and content analysis. The literature was dominated by medicine and nursing student placement research. No literature explicitly defined quality in rural health student placements, although proxy indicators for quality such as satisfaction, positive experiences, overall effectiveness and perceived value were identified. Content analysis resulted in four overarching domains pertaining to features of rural health student placement quality: (1) learning and teaching in a rural context, (2) rural student placement characteristics, (3) key relationships and (4) required infrastructure. CONCLUSION The findings suggest that quality in rural health student placements hinges on contextually specific features. Further research is required to explore these findings and ways in which these features can be measured during rural health student placements.
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Affiliation(s)
- Elyce Green
- Three Rivers University Department of Rural Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Claire Quilliam
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
| | - Lyndal Sheepway
- La Trobe Rural Health School, La Trobe University, Wodonga, Victoria, Australia
| | - Catherine A Hays
- Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
| | - Leigh Moore
- Rural and Remote Health, Flinders University, Darwin, Northern Territory, Australia
| | - Rohan L Rasiah
- Western Australian Centre for Rural Health, The University of Western Australia, Karratha, Western Australia, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Christine Howard
- Three Rivers University Department of Rural Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Sarah Hyde
- Joint Program in Medicine School of Rural Medicine, Charles Sturt University, Orange, New South Wales, Australia
| | - Imo Inyang
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia
| | - Kylie Matthews
- Majarlin Kimberley Centre for Remote Health, The University of Notre Dame, Broome, Western Australia, Australia
| | - Jane Ferns
- Department of Rural Health, The University of Newcastle, Taree, New South Wales, Australia
| | - Leanne J Brown
- Department of Rural Health, The University of Newcastle, Taree, New South Wales, Australia
| | - Sara Jones
- Department of Rural Health, University of South Australia, Whyalla, South Australia, Australia
| | - Marjorie Collett
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia, Australia
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Harvey P, Nightingale C, Kippen R. Rural medical students' self-reported perceptions of preparedness to practice in the Aboriginal and Torres Strait Islander Health Context. Aust J Rural Health 2021; 29:261-266. [PMID: 33793025 DOI: 10.1111/ajr.12721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/25/2020] [Accepted: 12/30/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Pamela Harvey
- School of Rural Health, Monash University, Bendigo, Vic., Australia
| | - Claire Nightingale
- Centre for Health Policy, University of Melbourne, Melbourne, Vic., Australia
| | - Rebecca Kippen
- School of Rural Health, Monash University, Bendigo, Vic., Australia
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Marcus K, Purwaningrum F, Short S. Towards more effective health workforce governance: The case of overseas-trained doctors. Aust J Rural Health 2021; 29:52-60. [PMID: 33631050 DOI: 10.1111/ajr.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/31/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The over-reliance on overseas-trained doctors remains a pressing problem in a handful of countries. This study aimed to explore the experience of rural and remote overseas-trained doctors as regards to their migration, recruitment and ongoing support in Australia as the basis for more effective health workforce governance. DESIGN Qualitative interviews were undertaken with overseas-trained doctors in rural and remote Australia. Interview questions focused on the experiences of overseas-trained doctors. SETTING Migrant doctors working in general practice in rural and remote Australia. PARTICIPANTS Overseas-trained doctors who met inclusion criteria participated in interviews (n=14), which were digitally recorded and transcribed. Thematic coding and analysis were conducted with input from the study's Expert Policy Stakeholder Group. RESULTS Overseas-trained doctors enjoyed the relative autonomy of working in rural or remote general practice and were grateful to be in Australia. Specialised rural and remote skills such as cultural competence in matters of Indigenous health and specialised emergency rural skills was a key finding as was the deskilling or lack of career development opportunities. Our analysis pointed to the mismatch in expectations and experiences between overseas-trained doctors, policy-makers and employers, as some doctors experienced obstacles with registration, or the location was not ideal, or there was a lack of awareness of Indigenous-related health and cultural challenges. CONCLUSIONS In the context of Australia's continuing reliance on overseas-trained doctors, this study revealed the need for improved communication and coordination between overseas-trained doctors, policy-makers (education, health, employment and immigration) and employers, as a basis for more effective health workforce governance.
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Affiliation(s)
- Kanchan Marcus
- Population Oral Health, School of Dentistry, Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Asia Pacific Migration Centre, School of Social and Political Sciences, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Farah Purwaningrum
- Sydney Asia Pacific Migration Centre, School of Social and Political Sciences, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie Short
- Sydney Asia Pacific Migration Centre, School of Social and Political Sciences, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, NSW, Australia.,Discipline of Behavioural and Social Sciences in Health, School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
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Koea J, Ronald M. What do indigenous communities want from their surgeons and surgical services: A systematic review. Surgery 2019; 167:661-667. [PMID: 31653491 DOI: 10.1016/j.surg.2019.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/07/2019] [Accepted: 08/17/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND This investigation was undertaken to define the factors determining the optimal and most productive relationship among indigenous communities, surgeons, and providers of surgical services. METHODS A systematic literature review was conducted to identify studies reporting on the experience of indigenous communities with surgeons, medical practitioners, and the providers of surgical and other health services. The databases searched were MEDLINE, EMBASE, PubMed, Web of Science, and Google Scholar, including all literature available until the search date of April 3, 2019. The reference lists of all included articles and related review articles were searched manually to identify further relevant studies. An inductive approach was used to identify common themes. RESULTS Thirty-three publications discussed the experiences of New Zealand Māori (n = 2), Aboriginal and Torres Strait Islanders (n = 20), North American First Nation (n = 10), and Indigenous Latin Americans (n = 1). Across all indigenous peoples, 6 themes emerged: accessible health services, community participation and community governance, continuous quality improvement, a culturally appropriate and clinically skilled workforce, a flexible approach to care, and holistic healthcare. CONCLUSION To provide medical and surgical services in indigenous communities successfully requires a diverse range of skills and core technical and academic competencies. Many skills lie within the definition of professionalism and advocacy as well as the ability to undertake and operationalize community consultation and empowerment. If surgical services serving Indigenous communities are to be successful in addressing health disparity, specific training in these skills will need to be developed and made available.
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Affiliation(s)
- Jonathan Koea
- Department of Surgery, North Shore Hospital, Auckland, New Zealand.
| | - Maxine Ronald
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
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Francis-Cracknell A, Murray M, Palermo C, Atkinson P, Gilby R, Adams K. Indigenous Health Curriculum and Health Professional Learners: A Systematic Review. MEDICAL TEACHER 2019; 41:525-531. [PMID: 30299183 DOI: 10.1080/0142159x.2018.1497785] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background: Globally, an estimated 370 million Indigenous peoples reside in more than 70 countries with these people commonly experiencing health care access inequity. Purpose: This systematic review aimed to examine the impact of Indigenous health care curriculum on entry-level health professional learners in preparation to deliver equitable health care. Methods: Seventeen articles were identified and analyzed for: context; study design; study measures, teaching and learning delivery mode, content and duration; positive and negative learner reactions; learning gained and article quality was assessed using the Medical Education Research Study Quality Instrument. Results: Most included studies described face-to-face delivery along with blended learning combining a placement in an Indigenous setting, stand-alone placements and digital learning. Descriptions of learning gained covered five domains: remembering, understanding, self-knowledge, perspective and application relating mostly to cultural awareness. Factors contributing to positive learner reactions included attitude, environment, educator skill, pedagogy and opportunities. Factors contributing to negative learner reactions included attitude and environment. Conclusions: There is a need to further explore how health professional graduates are prepared to work in Indigenous health and the appropriate measures to do this. There is opportunity to learn more about Indigenous health teaching and learning across learning domains, in mainstream clinical placements and in digital learning.
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Affiliation(s)
| | - Margaret Murray
- b Faculty of Medicine Nursing and Health Sciences, Department of Nutrition and Dietetics , Monash University , Clayton , Australia
| | - Claire Palermo
- c Department of Nutrition and Dietetics , Monash University , Melbourne , Australia
| | - Petah Atkinson
- a Faculty of Medicine Nursing and Health Sciences , Monash University , Frankston , Australia
| | - Rose Gilby
- d Department of Rural and Indigenous Health , Monash University , Mildura , Australia
| | - Karen Adams
- a Faculty of Medicine Nursing and Health Sciences , Monash University , Frankston , Australia
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Svarc R, Davis C, McDonald H, Perruzza J, Browne J, Delbridge R, Morgan K, O'Reilly S, Margerison C, Palermo C. Exploring the impact of Aboriginal health placement experiences on the preparation of dietetic graduates for practice with Aboriginal communities. Nutr Diet 2018; 75:448-456. [PMID: 29436176 DOI: 10.1111/1747-0080.12407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/19/2017] [Accepted: 01/01/2018] [Indexed: 11/30/2022]
Abstract
AIM A health workforce with the ability to practice with Aboriginal communities is crucial to bridge the health gap between Aboriginal and non-Aboriginal Australians. This study aimed to explore the impact of university Aboriginal health placements on preparing dietetic graduates for practice with Aboriginal communities. METHODS A mixed methods sequential explanatory design was used. A sample of 594 dietetic graduates was invited to complete a survey that identified Aboriginal health experiences and measured attitudes and self-confidence towards working in Aboriginal health using a five-point Likert scale. Participants were divided into placement versus no-placement groups and compared using chi-squared tests. Sixteen of 33 participants who had completed an Aboriginal health placement were invited to participate in a semi-structured interview to explore how placement influenced practice with Aboriginal communities. Interviews were analysed using content analysis. RESULTS A final sample of 120 participants showed that placement participants reported significantly higher self-confidence towards working in Aboriginal health compared with no-placement participants (No-placement = 35% agree, 36% neutral, 29% disagree; Placement = 74% agree, 11% neutral, 16% disagree; χ2 (2, 88) = 9.4; P = 0.01). Fifteen participants were interviewed. Interview data indicated that situated learning experiences, breaking down stereotypes, empathy through learning from Aboriginal people, and Aboriginal health role-models were key components of Aboriginal health placements in preparing dietetic graduates for practice with Aboriginal communities. CONCLUSIONS The results suggest that Aboriginal health placements may be an effective strategy for preparing dietetic graduates for practice with Aboriginal communities. The feasibility of placement or alternative curriculum content needs to be explored.
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Affiliation(s)
- Ruby Svarc
- Department of Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia
| | - Corinne Davis
- Department of Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia
| | - Helena McDonald
- Department of Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia
| | - Julia Perruzza
- Department of Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Browne
- Public Health and Research Unit, The Victorian Aboriginal Community Controlled Health Organisation, Melbourne, Victoria, Australia
| | - Robyn Delbridge
- Public Health and Research Unit, The Victorian Aboriginal Community Controlled Health Organisation, Melbourne, Victoria, Australia
| | - Keith Morgan
- Public Health and Research Unit, The Victorian Aboriginal Community Controlled Health Organisation, Melbourne, Victoria, Australia
| | - Sharleen O'Reilly
- UCD Agriculture and Food Science Centre, University College Dublin, Dublin, Ireland
| | - Claire Margerison
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Claire Palermo
- Department of Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia
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