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Towards Reconciliation in Aboriginal Health: Initiatives for Teaching Medical Students About Aboriginal Issues

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Towards Reconciliation in Aboriginal Health: Initiatives for Teaching Medical Students About Aboriginal Issues 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 1 Towards Reconciliation in Aboriginal Health: Initiatives for Teaching Medical Students about Aboriginal Issues Lisa Rasmussen The VicHealth Koori Health Research and Community Development Unit The Centre for the Study of Health and Society School of Population Health The University of Melbourne 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 2 First published in 2001 by The VicHealth Koori Health Research and Community Development Unit Centre for the Study of Health and Society School of Population Health The University of Melbourne 209 Grattan St Parkville Victoria 3052 The views expressed in this publication are those of the author and not necessarily those of the VicHealth Koori Health Research and Community Development Unit. © Lisa Rasmussen 2001 This book is copyright. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the Copyright Act, no part may be reproduced by any process without written permission. [NLA CIP-data] Edited by Kate Foord Photos by Peter Gibson Cover Photo: Pilot Teaching Project at Brambuk - Aboriginal Cultural Centre, Grampians/Gariwerd National Park Cover designed by Amanda Sze Produced by Amanda Sze Printed by The Design & Print Centre The University of Melbourne ISBN 0 7340 2109 7 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 3 Towards Reconciliation in Aboriginal Health: Initiatives for Teaching Medical Students about Aboriginal Issues Lisa Rasmussen The VicHealth Koori Health Research and Community Development Unit The Centre for the Study of Health and Society School of Population Health The University of Melbourne 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 4 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 5 Dedication This report is dedicated to Peter Clarke who died in January 1999, aged thirty. Peter was a Koori educator and a member of the advisory committee for this project. In addition to his long-standing commitment towards a more appropriate and accessible education system for young Kooris, Peter was involved for many years in increasing the awareness amongst other Australians about Indigenous issues. He treated people with great respect and believed that it was particular experiences, as well as lack of contact and a lack of information, which were key to the beliefs and perceptions non-Indigenous Australians often carried about his people. He was strongly committed to the power of educational processes in bringing about positive and lasting change in this area. Peter’s ideas about cross-cultural teaching were central in the development of the pilot project and he made a lasting impression on all thirty- two students who participated. All of us involved in this project will never forget him. 5 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 6 6 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 7 Acknowledgments Research and teaching, particularly in the area of Aboriginal health, are dependent on the collaboration and involvement of a wide range of people and organisations, so there are many to acknowledge. Firstly, I would like to thank the co-investigators, Ian Anderson, Ellen Herlihy and Agnes Dodds, along with Peter Clarke, Danni Stewart and Richard Kjar who formed the steering committee. They brought with them a range of experiences and expertise and their advice and guidance was invaluable. Secondly, I would like to thank all those who were involved in the delivery of the pilot project: the staff at Brambuk, in particular Mark Mathews and Tim Chatfield; our facilitators, Peter Adams, Ian Anderson, Mary Belfrage, Shaun Coade, Shannon Faulkhead, Victoria Hartcup, Andrea James, Niall Quiery, Doug Smith, Joyce Smith, Angelina Tabuteau, Lisa Thorpe, Robbie Thorpe, Chris Twining, Charles Williams; and those who helped with organisational aspects of the weekend including Bruce Clezy and Antoinette Smith. I would also like to acknowledge the staff at the following organisations, who were involved in the urban tour and who made time for the students despite the demands of their work: the Victorian Aboriginal Health Service (VAHS), the Aborigines Advancement League, Yappera, the Aboriginal Community Elders Service (ACES) and the Aboriginal Housing Board of Victoria. I would like to thank the following individuals who gave up so much of their time in the second phase of the project: Neville Austin, Reg Blow, Frances Charles, Gary Hansen, Joanne Honneysett, Bev Murray, Jacqui Stewart, Berryl Thomas, Fay Thorpe, the Clarke family, Sonja Hodge and Indi. With respect to the survey analysis, I would like to thank Patty Chondros and Suzanne Vidma, Angelina Tabuteau and Danni Stewart. I would also like to thank Sonya Tremellen for her advice on evaluation processes, and Dick Sloman, Emma Koval, Priscilla Pyett and Kate Foord for their editorial comments and encouragement during various drafts of the work. I would particularly like to thank Ngaire Kerse who donated many hours of her time helping me come to grips with SPSS and data analysis, and Christine Phillips whose advice was invaluable with respect to the structure and editing of the final document. I would also like to thank Margot Rasmussen, Christina Rasmussen and Bruce Clezy for their hours of childcare. Finally, thanks go to the University of Melbourne’s Department of General Practice (formally known as the Department of General Practice and Public Health) for initiating the project and supporting the development and delivery of the focus group discussions, the surveys and the pilot teaching project, and to the VicHealth Koori Health Research and Community Development Unit for supporting the completion and publication of the research. 7 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 8 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 9 Contents ABBREVIATIONS 17 LIST OF TABLES 13 LIST OF FIGURES 15 PREFACE 19 SECTION 1: WHY THIS PROJECT? 21 CHAPTER ONE: THE PROBLEM 23 1.1 Why does teaching Aboriginal health matter? 16 1.2 Aboriginal health teaching at the University of Melbourne 25 1.3 Towards an improved curriculum in Aboriginal health 27 SECTION 2: NEEDS ASSESSMENT 29 CHAPTER TWO: LITERATURE REVIEW 31 2.1 Recommendations on Aboriginal health teaching 31 2.2 Imagining Aboriginality: what students bring to learning about Aboriginal health 35 2.3 Theoretical frameworks for cross-cultural learning in health 38 2.4 Teaching Aboriginal health to undergraduate medical students: what models exist for more successful teaching? 41 2.4.1 Structural issues 41 2.4.2 Examples of discrete teaching initiatives in Aboriginal health 43 2.5 Summary 49 CHAPTER THREE: FOCUS GROUP DISCUSSIONS 51 3.1 Introduction 51 3.2 Methodology 51 3.2.1 Focus group discussions: development and delivery 51 3.2.2 Analysis 52 3.3 Results 52 3.3.1 Emotions that students bring to the learning experience 52 3.3.2 Key issues that provoked strong emotion 55 3.3.3 Students’ perceptions of Aboriginal culture and Aboriginal people 58 3.3.4 Key influences on student understanding of Aboriginal issues 62 9 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 10 3.3.5 Medical relationships with Aboriginal people: students’ perceptions of themselves as future doctors 66 3.5 Summary and discussion 67 CHAPTER FOUR: SURVEY OF STUDENTS’ UNDERSTANDING OF ABORIGINAL HEALTH AND ABORIGINAL ISSUES 71 4.1 Introduction 71 4.2 Methodology 71 4.2.1 Survey content and administration 71 4.2.2 Data Analysis 72 4.3 Results 73 4.3.1 Demographic data 73 4.3.2 Students’ self-assessed knowledge of Aboriginal issues 75 4.3.3 General knowledge about Aboriginal health 76 4.3.4 Students’ perceptions of the causes of poor health 78 4.3.5 Key influences on student understanding of Aboriginal issues 81 4.3.6 Critical events in influencing student understanding 82 4.3.7 Student assessment of their future work in Aboriginal health 83 4.4 Discussion 85 4.5 Summary 88 CHAPTER FIVE: SURVEY OF STUDENT ATTITUDES TOWARDS TEACHING IN ABORIGINAL HEALTH 89 5.1 Introduction 89 5.2 Methodology 90 5.2.1 Survey Content 90 5.2.2 Data analysis 90 5.3 Results 90 5.3.1 Student evaluation of the role of Aboriginal health teaching 91 5.3.2 Student evaluation of past teaching experiences 94 5.3.3 Student attitudes to future teaching 97 5.3.4 Structural issues relating to Aboriginal health teaching 97 5.4 Discussion 101 10 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 11 5.4.1 Teaching strategies 101 5.4.2 Integrating Aboriginal health into the medical curriculum 102 5.5 Summary 103 CHAPTER SIX: FUTURE DIRECTIONS 105 6.1 Barriers and enhancers to learning about Aboriginal health: a model 105 6.2. Barriers to learning about Aboriginal health and related issues 107 6.2.1 Structural factors 107 6.2.2 Teaching Factors 107 6.2.3 Student factors 108 6.3 Identified factors that can facilitate learning about Aboriginal health and related issues 110 6.3.1 Structural factors 111 6.3.2 Teaching Factors 111 6.3.3 Student factors 112 SECTION 3: INTERVENTION 113 CHAPTER SEVEN: PILOT TEACHING PROJECT 115 7.1 Introduction 115 7.2 Project aims 116 7.3 Project description: development and delivery 116 7.3.1 Selection 117 7.3.2 Orientation 118 7.3.3 Weekend at Brambuk 119 7.3.4 Urban Tour 119 7.3.5 Post-pilot project meetings with students 120 7.4 Project evaluation 120 7.4.1 Introduction 120 7.4.2 Findings 121 7.5 Discussion 132 7.5.1 Features which contributed to the project’s success 133 11 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 12 SECTION 4: CONCLUSION 143 CHAPTER EIGHT: CONCLUSION AND RECOMMENDATIONS 145 APPENDICES 151 APPENDIX 1: Steering Committee 153 APPENDIX 2: Questions and Student Handouts for Focus Group Discussions 155 Stream One 155 Stream Two 156 Handout 1: Quote 156 Handout 2: Case Study 157 APPENDIX 3: Student Survey 159 APPENDIX 4: Pilot Teaching Project, Brambuk - Collection of Readings 167 APPENDIX 5: Students’ Learning Requests from Pilot Project Orientation Meetings 169 APPENDIX 6: The Challenging Racism Game 171 APPENDIX 7: Evaluation Forms 173 APPENDIX 8: Pilot Teaching Project: Brambuk Program and Process Evaluation 179 BIBLIOGRAPHY 187 12 4817-Aboriginal Hlthv2 31/3/03 9:46 AM Page 13 List of Tables TABLE 1-1.
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