Understanding practitioner professionalism in Aboriginal and Torres Strait Islander health: lessons from student and registrar placements at an urban Aboriginal and Torres Strait Islander primary healthcare service
Deborah A. Askew A B , Vivian J. Lyall A F , Shaun C. Ewen C , David Paul D and Melissa Wheeler EA Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Health, Qld 4077, Australia.
B Discipline of General Practice, University of Queensland, Qld 4029, Australia.
C Melbourne Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Vic. 3010, Australia.
D Aboriginal Health, School of Medicine Fremantle, University of Notre Dame, WA 6959, Australia.
E Centre for Ethical Leadership, University of Melbourne, Vic. 3010, Australia.
F Corresponding author. Email: vivian.lyall@health.qld.gov.au
Australian Journal of Primary Health 23(5) 446-450 https://doi.org/10.1071/PY16145
Submitted: 11 November 2016 Accepted: 27 May 2017 Published: 15 August 2017
Abstract
Aboriginal and Torres Strait Islander peoples continue to be pathologised in medical curriculum, leaving graduates feeling unequipped to effectively work cross-culturally. These factors create barriers to culturally safe health care for Aboriginal and Torres Strait Islander peoples. In this pilot pre-post study, the learning experiences of seven medical students and four medical registrars undertaking clinical placements at an urban Aboriginal and Torres Strait Islander primary healthcare service in 2014 were followed. Through analysis and comparison of pre- and post-placement responses to a paper-based case study of a fictitious Aboriginal patient, four learning principles for medical professionalism were identified: student exposure to nuanced, complex and positive representations of Aboriginal peoples; positive practitioner role modelling; interpersonal skills that build trust and minimise patient–practitioner relational power imbalances; and knowledge, understanding and skills for providing patient-centred, holistic care. Though not exhaustive, these principles can increase the capacity of practitioners to foster culturally safe and optimal health care for Aboriginal peoples. Furthermore, competence and effectiveness in Aboriginal health care is an essential component of medical professionalism.
Additional keywords: Aboriginal health, medical education, practitioner bias.
References
Askew D, Ewen S, Paul D (2017) Shifting understandings: do scenario-based clinical decisions change with immersion? In ‘LIME Good Practice Case Studies Volume Four 2017’. (Eds O Mazel, C Ryan) (Leaders in Indigenous Medical Education Network, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne: Melbourne, Vic., Australia)Australian Medical Council (2012) Standards for assessment and accreditation of primary medical programs by the Australian Medical Council 2012. (Australian Medical Council: Canberra, ACT, Australia) Available at http://www.amc.org.au/files/d0ffcecda9608cf49c66c93a79a4ad549638bea0_original.pdf [Verified 27 June 2017]
Balint E (1969) The possibilities of patient-centered medicine. The Journal of the Royal College of General Practitioners 17, 269–276.
Birden H, Glass N, Wilson I, Harrison M, Usherwood T, Nass D (2014) Defining professionalism in medical education: a systematic review. Medical Teacher 36, 47–61.
| Defining professionalism in medical education: a systematic review.Crossref | GoogleScholarGoogle Scholar |
Bond C, Foley W, Askew D (2016) ‘It puts a human face on the researched’ – a qualitative evaluation of an Indigenous health research governance model. Australian and New Zealand Journal of Public Health 40, S89–S95.
| ‘It puts a human face on the researched’ – a qualitative evaluation of an Indigenous health research governance model.Crossref | GoogleScholarGoogle Scholar |
Cass A, Lowell A, Christie M, Snelling PL, Flack M, Marrnganyin B, Brown I (2002) Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. The Medical Journal of Australia 176, 466–470.
Epstein RM, Hundert EM (2002) Defining and assessing professional competence. Journal of the American Medical Association 287, 226–235.
| Defining and assessing professional competence.Crossref | GoogleScholarGoogle Scholar |
Ewen SC, Hollinsworth D (2016) ‘Unwell while Aboriginal’: iatrogenesis in Australian medical education and clinical case management. Advances in Medical Education and Practice 7, 311–315.
| ‘Unwell while Aboriginal’: iatrogenesis in Australian medical education and clinical case management.Crossref | GoogleScholarGoogle Scholar |
Ewen SC, Barrett J, Paul D, Askew D, Webb G, Wilkin A (2015) When a patient’s ethnicity is declared, medical students’ decision-making processes are affected. Internal Medicine Journal 45, 805–812.
| When a patient’s ethnicity is declared, medical students’ decision-making processes are affected.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2MfgvVehtQ%3D%3D&md5=ee227ae7b2ce59facfcf90ce56bc7d02CAS |
Hayman NE, Askew DA, Spurling GK (2014) From vision to reality: a centre of excellence for Aboriginal and Torres Strait Islander primary health care. The Medical Journal of Australia 200, 623–624.
| From vision to reality: a centre of excellence for Aboriginal and Torres Strait Islander primary health care.Crossref | GoogleScholarGoogle Scholar |
Kirk LM (2007) Professionalism in medicine: definitions and considerations for teaching. Baylor University Medical Center Proceedings 20, 13–16.
Murray RB, Larkins S, Russell H, Ewen S, Prideaux D (2012) Medical schools as agents of change: socially accountable medical education. The Medical Journal of Australia 196, 653
| Medical schools as agents of change: socially accountable medical education.Crossref | GoogleScholarGoogle Scholar |
Paul D, Ewen SC, Jones R (2014) Cultural competence in medical education: aligning the formal, informal and hidden curricula. Advances in Health Sciences Education – Theory and Practice 19, 751–758.
| Cultural competence in medical education: aligning the formal, informal and hidden curricula.Crossref | GoogleScholarGoogle Scholar |
Pearson D, Walpole S, Barna S (2015) Challenges to professionalism: social accountability and global environmental change. Medical Teacher 37, 825–830.
| Challenges to professionalism: social accountability and global environmental change.Crossref | GoogleScholarGoogle Scholar |
Phelan SM, Puhl RM, Burke SE, Hardeman R, Dovidio JF, Nelson DB, Przedworski J, Burgess DJ, Perry S, Yeazel MW, van Ryn M (2015) The mixed impact of medical school on medical students’ implicit and explicit weight bias. Medical Education 49, 983–992.
| The mixed impact of medical school on medical students’ implicit and explicit weight bias.Crossref | GoogleScholarGoogle Scholar |
van Ryn M, Hardeman R, Phelan SM, Burgess DJ, Dovidio JF, Herrin J, Burke SE, Nelson DB, Perry S, Yeazel M, Przedworski JM (2015) Medical school experiences associated with change in implicit racial bias among 3547 students: a medical student CHANGES study report. Journal of General Internal Medicine 30, 1748–1756.
| Medical school experiences associated with change in implicit racial bias among 3547 students: a medical student CHANGES study report.Crossref | GoogleScholarGoogle Scholar |
Weissman JS, Betancourt J, Campbell EG, Park ER, Kim M, Clarridge B, Blumenthal D, Lee KC, Maina AW (2005) Resident physicians’ preparedness to provide cross-cultural care. Journal of the American Medical Association 294, 1058–1067.
| Resident physicians’ preparedness to provide cross-cultural care.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXpvVSju7Y%3D&md5=0f38a6f8912ec67984ac81c2f5014819CAS |
