Working together to make Indigenous health care curricula everybody's business: a graduate attribute teaching innovation report

Transgender and gender diverse curriculum in medical imaging programs: a case study

BACKGROUND

Transgender and gender diverse (TGD) individuals face barriers, including harassment and discrimination, when accessing healthcare services. Medical imaging procedures require personal information to be shared, such as date of last menstrual cycle and/or pregnancy status; some imaging exams are also invasive or intimate in nature. Terminology is based on binary sex creating an inherently cis-heteronormative environment. TGD patients fear being outed and often feel a need to function as educators and advocates for their care. Incorporation of inclusive healthcare curriculum related to TGD populations is an effective means of educating new health providers and promotes safer and more inclusive spaces in healthcare settings. Educators face barriers which hinder the creation and implementation of TGD content. The purpose of this study was to examine the impacts educators are faced with when creating and delivering TGD content in their medical imaging curriculum.

METHODS

A case study of medical imaging programs at a Canadian post-secondary institute was undertaken. Data was collected via semi-structured interviews with faculty. Relevant institutional documents such as strategic plans, policies/procedures, websites, and competency profiles were accessed. Framework analysis was used to analyze the data.

RESULTS

The study found seven themes that influence the development of TGD curriculum as follows: familiarity and comfort with the curriculum and content change process; collaboration with other healthcare programs; teaching expertise; management of course workload and related. duties; connections to the TGD community; knowledge of required TGD content and existing gaps in curriculum; and access to supports.

CONCLUSIONS

Understanding educators' perspectives can lead to an increased sense of empowerment for them to create and incorporate TGD curriculum in the future. Many post- secondary institutions are incorporating an inclusive lens to educational plans; this research can be used in future curriculum design projects. The goal is improved medical imaging experiences for the TGD population.

Exploring First Nations' and Cultural Safety Content of Pharmacy Curricula With Academics in Australia

OBJECTIVE

This study aimed to explore academics' views on Aboriginal and/or Torres Strait Islander Health and Cultural Safety content in pharmacy school curricula to inform recommendations for future curricula.

METHODS

All 18 Australian pharmacy schools were contacted, and interviews were conducted with consenting heads of school and/or their delegate(s). The interviews covered what the school was doing with respect to the First Nations theme in the revised accreditation standards and further ideas for improvement. Audio recordings of interviews were transcribed verbatim via an online transcription service. Transcripts were thematically analyzed and coded according to the framework approach and mapped to the Aboriginal and Torres Strait Islander Health Curriculum Framework. Coding was facilitated using NVivo software.

RESULTS

All 18 schools consented to participate and a total of 22 interviews were conducted. The pharmacy accreditation standards were well known to most educators, however, the dissemination of the Aboriginal and Torres Strait Islander Health Curriculum Framework, introduced in 2014, appeared to be poor. Many interviewees (n = 14) expressed that the current content regarding Aboriginal health and cultural safety/competence was lacking and cited barriers that have led to a lack of development such as a lack of First Nations staff and expertize.

CONCLUSION

While cultural safety/competency was taught in all Australian pharmacy schools, it is apparent that pharmacy schools are at various stages in their development of Aboriginal and Torres Strait Islander Health curriculum design and implementation. Future resources should be developed and made available.

Developing culturally safe education practices in optometry schools across Australia and Aotearoa New Zealand

Access to culturally safe health services is a basic human right, however through the lasting effects of colonisation, oppression, and systemic racism, the individual and community health of Indigenous peoples in Australia and Aotearoa New Zealand have been severely impacted. The Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy of the Australian Health Practitioners Regulation Agency, and the Standards of Cultural Competence and Cultural Safety of the Optometrists and Dispensing Opticians Board of New Zealand, recognise the importance of access to safe health care for Aboriginal, Torres Strait Islander and Māori patients, which encompasses both clinical competency and cultural safety. Universities have an ongoing responsibility to ensure their learning and teaching activities result in graduates being able to provide culturally safe practice. This article highlights the emergence of culturally safe practices in the Australian and Aotearoa New Zealand optometry curricula over the last five years incorporating Indigenous ways of knowing, being and doing into the curricula, understanding the local Indigenous histories and contexts, the adoption of online cultural education modules, and clinical placement partnerships with local Indigenous communities. Whilst there is still much work to do to achieve the goal of graduating culturally safe optometrists, this paper focuses on features that enable or impede progress in the development of culturally safe practices within the optometry programmes to improve eye health equity for Indigenous recognise the diversity of Indigenous cultures across Australia and NZ.

'Maybe what I do know is wrong…': Reframing educator roles and professional development for teaching Indigenous health

Settler colonisation continues to cause much damage across the globe. It has particularly impacted negatively on Indigenous peoples' health and wellbeing causing great inequity. Health professional education is a critical vehicle to assist in addressing this; however, non-Indigenous educators often feel unprepared and lack skill in this regard. In this qualitative study, 20 non-Indigenous nursing, physiotherapy and occupational therapy educators in Australia were interviewed about their experiences and perspectives of teaching Indigenous health. Findings from the inductive thematic analysis suggest educators require skill development to: identify their discomfort in teaching cultural safety; contextualise the sources of this discomfort and; reflect on how this understanding can improve their teaching. Additionally, educators require professional training to become practitioners of cultural humility and to be facilitators and colearners (rather than experts) of the Aboriginal-led curriculum. Of relevance to this is educator training in how to decentre non-Indigenous needs and perspectives. Educators can also renew their teaching practices by understanding what a dominant settler paradigm is, identifying if this is problematically present in their teaching and knowing how to remedy this. Crucial to improved cultural safety teaching is institutional support, which includes Indigenous leadership, institutional commitment, relevant policies, and well-designed professional development.

Clinical yarning with Aboriginal and/or Torres Strait Islander peoples-a systematic scoping review of its use and impacts

OBJECTIVES

To explore how clinical yarning has been utilised as a health intervention for Aboriginal and/or Torres Strait Islander peoples and if there are any reported impacts yarning might have on health outcomes.

STUDY DESIGN

Systematic scoping review of published literature.

DATA SOURCES

A one-word search term "yarning" was applied in Scopus, EMBASE, CINAHL, MEDLINE, International Pharmaceutical Abstracts, Australian Public Affairs Information Service-Health, and the Aboriginal and/or Torres Strait Islander Health Bibliography databases. Databases were searched from inception to May 20, 2020.

STUDY SELECTION

Studies were included where clinical yarning had been used as a health intervention. Inclusion and exclusion criteria were developed and applied according to PRISMA systematic and scoping review reporting methods.

DATA SYNTHESIS

A total of 375 manuscripts were found from the initial data search. After removal of duplicates and removal of manuscripts based on abstract review, a total of 61 studies underwent full-text review. Of these, only five met the inclusion criteria of utilising yarning as a clinical intervention. Four of these studies described consumer self-reported health outcomes, with only one study looking at improvements in objective physiological health outcomes.

CONCLUSIONS

Whilst clinical yarning may be a culturally appropriate intervention in healthcare, there are limited studies that have measured the impact of this intervention. Further research may be needed to ascertain the true benefits of this intervention.

An Environmental Scan of Indigenous Cultural Safety in Canadian Baccalaureate Nursing and Midwifery Programs

BACKGROUND

The Truth and Reconciliation Commission (TRC) TRC has called to increase the number of Indigenous practitioners and include cultural competency education in their curricula. However, it remains unknown how nursing and midwifery programs are progressing towards these goals.

PURPOSE

To examine the extent to which baccalaureate nursing and midwifery programs are creating culturally safe spaces for Indigenous students, responding to TRC-recommended curricular changes, and including Indigenous content.

METHODS

A digital environmental scan of accredited baccalaureate nursing and midwifery programs in Canada was conducted. Analysis was conducted using descriptive statistics.

RESULTS

Of the 107 programs, less than one-fifth (n = 19, 17.8%) met all three cultural safety criteria. More than half (n = 59, 55.1%) included culturally safe spaces for Indigenous students, 20 (18.7%) satisfied TRC call #24 to require Indigenous-relevant coursework, and one-third (n = 36, 33.6%) were seen as infusing their curricula with Indigenous-related content.

CONCLUSIONS

This represents the first attempt to systematically catalog nursing and midwifery programs' response to the TRC Calls to Action. Most schools have not made substantial progress towards cultural safety. Nursing and midwifery programs should commit to expanding their cultural safety programming to incorporate multiple ways of knowing and being in their curricula.

Integrating equity and social justice for indigenous peoples in undergraduate health professions education in Canada: a framework from a critical review of literature

Understanding how to create structural change by actively counteracting racialized ways of interacting with Indigenous peoples at an individual and organizational level within health care systems and health professions education is essential for creating a more inclusive, equitable, and healthier society. In health professions education, the primary means of teaching about health inequities has been to frame them as stemming from culturally or ethnically based issues. While attention to culturally specific practices can be valuable to health and healing in some contexts, education that solely focuses on Indigenous cultures risks perpetuating cultural stereotypes and othering, rather than focusing on how Eurocentric systems continue to exert oppressive effects on Indigenous peoples. We present an organizational transformation framework grounded in equitable partnerships from a comprehensive critical review of the literature on the integration of equity and social justice in undergraduate health professions education with a focus on Indigenous health. We did a thematic analysis of the results and discussions presented in the 26 selected articles to identify promising practices and challenges associated with the integration of equity and social justice in undergraduate health professions education. The framework resulting from this analysis is composed of three interrelated components: 1) adopt critical pedagogical approaches that promote Indigenous epistemologies; 2) partner with Indigenous students, educators and communities; 3) engage educators in critical pedagogical approaches and health equity issues. This framework could guide the development of contextually tailored interventions that contribute to decolonizing health professions education.

How prepared is Australian occupational therapy to decolonise its practice?

INTRODUCTION

Being culturally secure, respectful and responsive can mean occupational therapists can contribute to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples. New culturally responsive accreditation and competency standards provide an opportunity to decolonise the profession to enhance the cultural capabilities of graduates. The purpose of this study was to explore how well-prepared Australian occupational therapy courses are to implement the new standards.

METHODS

The principles of participatory action research were applied. An initial survey with occupational therapy academic staff was used to inform questions for semi-structured interviews. Semi-structured interviews were conducted with 10 occupational therapy academics and occupational therapy accreditors. Interview data were thematically analysed.

FINDINGS

The four themes identified from the interviews were: occupational therapy profession drivers, effective leadership, community and Elder involvement, and course design and delivery.

CONCLUSION

The new accreditation and competency standards are a promising step forward for the profession. However, the profession needs to be better prepared to decolonise Australian occupational therapy. A positive and culturally secure way forward is to engage Elders and other community members in learning experiences to build student, academic and practicing occupational therapist's cultural capability. Non-Aboriginal and Torres Strait Islander leadership at all levels of the profession and within universities is crucial to establishing trusting, reciprocal relationships to support deep knowledge exchange. These relationships lay the foundation to build cultural capabilities and decolonise processes in the profession.

Educator perceptions on teaching Indigenous health: Racism, privilege and self-reflexivity

INTRODUCTION

General practitioners (GPs) and family medicine clinicians should respond to Indigenous peoples' health needs. However, medical graduates feel underprepared for this work. The foundational elements of racism, white privilege and cultural self-reflexivity remain conspicuously absent from medical education in general practice programmes, despite inclusion in curriculum frameworks. This study explored the perception and experiences of Australian GP educators in teaching this content.

METHODS

We undertook a qualitative study that gathered data through semi-structured interviews with GP educators (n = 12) at a medical school in Victoria, Australia. We utilised the Reflection learning domain of the Aboriginal and Torres Strait Islander Health Curriculum Framework to shape interview questions on racism, white privilege and cultural self-reflexivity. Data were analysed from constructivist and Critical Indigenous Theory paradigms to formulate key themes.

RESULTS

General practitioner educators were challenged by Reflection content, struggled to articulate a refined pedagogy for provision of anti-racist, self-reflexive learning and felt poorly qualified to teach Indigenous health, articulating preference for delegation of teaching to Indigenous peoples. They simultaneously stated the importance of inclusion of Reflection teaching in general practice, alongside expressing beliefs that appeared to devalue its perceived relevance. Students were perceived as being either disinterested or incapable of Reflection learning, or conversely, more engaged than previous generations with these topics.

DISCUSSION

The results call into question how skilled are GP educators to teach elements of Indigenous health education such as racism, white privilege and cultural self-reflexivity. Unskilled educators can reinforce colonialism in curricula, including through minimisation of content. Stronger anti-racist pedagogy is urgently required in medical education. Vital to this is active research on educator preparedness, evidence-based teaching models and accountable curriculum accreditation.

Action research to implement an Indigenous health curriculum framework

In recent decades Indigenous health curriculum frameworks have been developed, however, few studies about their implementation exist. This study aimed to employ critical theory and action research to understand how an Indigenous health curriculum framework could be applied and associated learning and teaching iteratively improved. Three action research cycles where conducted from 2017 to 2019. Student reaction (satisfaction and engagement) was collected via survey 2017-2019. Student learning was collated 2018-2019 via self-perception survey (knowledge, attitude, confidence, commitment); multi-choice questions (knowledge) and; content analysis of apply and analyse activities (skill). The teaching team met annually to reflect on findings and plan enhancements to learning and teaching. Over 2017-2019 there was a pattern of improved student reaction and learning. Connecting this research to Faculty level committees led to widening success and improved sustainability of the practice. The online unit and workshop delivery were scalable, overcame a barrier of educator skill and confidence to teach this area, allowed for quality content control and provided data for analysis. Interestingly, learning gained from this unit matched that described as occurring from student placements in health settings with high numbers of Indigenous people. Student learning occurred across the Framework three levels (novice, intermediate and entry to practice) suggesting that the taxonomy of the Framework does not necessarily align with the reality of learning and teaching. Vertical implementation of the five learning domains would benefit from alignment with training evaluation models and validated assessment to understand learning that has occurred rather than the teaching that has been taught. In this study health profession accreditation bodies had driven the imperative for an Indigenous health program and curriculum. Research on Indigenous health learning and teaching relating to behaviour and results in workplaces is needed.

Indigenous Health Curriculum and Health Professional Learners: A Systematic Review

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.

Cultural safety continuing professional development for midwifery academics: An integrative literature review

BACKGROUND

Awareness of cultural safety by midwifery academics is integral to the provision of a safe learning and teaching environments, use of effective pedagogies, and academic success of Indigenous midwifery students. However, little is known about the scope and efficacy of continuing professional development activities that aim to develop awareness of cultural safety by midwifery academics.

AIMS

To conduct an integrative review of the literature with respect to the scope and efficacy of professional development interventions that aim to increase awareness of cultural safety by midwifery academics.

METHODS

An integrative review of peer-reviewed literature from 2005 -2017 was undertaken. Documents were assessed using the Critical Appraisals Skills Program (CASP) guidelines. Concepts were mapped thematically.

RESULTS

Results are reported and discussed using key themes identified in the analysis. Five broad themes emerged from the analysis of studies. The themes were named: Cultural Terms, Knowledge of Culture, Cultural Education, Cultural Aspirations and Culture in Curricula.

CONCLUSIONS

Midwifery academics requireprofessional development to raise their awareness of cultural safety in order to adopt effective learning and teaching practices. There is currently no agreed best practice framework to support awareness of cultural safety for midwifery academics. The philosophy of midwifery practice has many synergies with the principles of cultural safety. Cultural safety needs to be embedded into professional development plans for midwifery academics.

REM

The well-documented health disparities between the Australian Indigenous and non-Indigenous population mandates a comprehensive response from health professionals. This article outlines the approach taken by one faculty of health in a large urban Australian university to enhance cultural competence in students from a variety of fields. Here we outline a collaborative and deeply respectful process of Indigenous and non-Indigenous university staff collectively developing a model that has framed the embedding of a common faculty Indigenous graduate attribute across the curriculum. Through collaborative committee processes, the development of the principles of “Respect; Engagement and sharing; Moving forward” (REM) has provided both a framework and way of “being and doing” our work. By drawing together the recurring principles and qualities that characterize Indigenous cultural competence the result will be students and staff learning and bringing into their lives and practice, important Indigenous cultural understanding.

Leadership as a Personal Journey: An Indigenous Perspective

Indigenous Australians have higher levels of mental illness, self-harm, suicide and substance abuse than non-Indigenous Australians, as well as more frequent contact with the criminal justice system. These indices point to the need for strong leadership to support Close the Gap programmes that have now been implemented across Australia. This article considers leadership as a journey of learning for Australian Indigenous leaders. Through the use of story, it is suggested that a situational leadership approach, incorporating the principles of mindfulness, provides the most appropriate framework for Indigenous leaders who work with Indigenous communities. Flexible approaches are needed to meet the needs of diverse Indigenous populations, and address the complex challenges involved, including lateral violence. Such flexibility will enable Indigenous leaders and communities to work together to achieve improvements in the health outcomes, not only for Indigenous Australians, but also for Indigenous populations worldwide.