Exposing the Hidden Curriculum Influencing Medical Education on the Health of Indigenous People in Australia and New Zealand

Ewen, Shaun; Mazel, Odette; Knoche, D

doi:10.1097/acm.0b013e31823fd777

Cited by 33 publications

(30 citation statements)

References 25 publications

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“…How training should and does proceed from there, how integration should occur into the general curriculum, and where the focus should lie at different stages of training has not been explored. An exploration of racism and its prevalence and impacts on patient care within General Practice will also help in understanding what other influences exist on GP registrar training in this area [8, 72]. …”

Section: Discussionmentioning

confidence: 99%

Developing cultural competence in general practitioners: an integrative review of the literature

2016

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BackgroundCultural competence is a broad concept with multiple theoretical underpinnings and conflicting opinions on how it should be materialized. While it is recognized that cultural competence should be an integral part of General Practice, literature in the context of General Practice is limited.The aim of this article is to provide a comprehensive summary of the current literature with respect to the following: the elements of cultural competency that need to be fostered and developed in GPs and GP registrars; how is cultural competence being developed in General Practice currently; and who facilitates the development of cultural competence in General Practice.MethodsWe conducted an integrative review comprising a systematic literature search followed by a synthesis of the results using a narrative synthesis technique.ResultsFifty articles were included in the final analysis. Cultural competence was conceptualized as requiring elements of knowledge, awareness/attitudes and skills/behaviours by most articles. The ways in which elements of cultural competence were developed in General Practice appeared to be highly varied and rigorous evaluation was generally lacking, particularly with respect to improvement in patient outcomes. Formal cultural competence training in General Practice appeared to be underdeveloped despite GP registrars generally desiring more training. The development of most aspects of cultural competence relied on informal learning and in-practice exposure but this required proper guidance and facilitation by supervisors and educators. Levels of critical and cultural self-reflection amongst General Practitioners and GP registrars varied and were potentially underdeveloped. Most standalone training workshops were led by trained medical educators however the value of cultural mentors was recognised by patients, educators and GP registrars across many studies.ConclusionsCultural competency development of GP registrars should receive more focus, particularly training in non-conscious bias, anti-racism training and critical self-reflectiveness. There is a need for further exploration of how cultural competence training is delivered within the GP training model, including clarifying the supervisor’s role.It is hoped this discussion will inform future research and training practices in order to achieve quality and respectful care to patients across cultures, and to remove health inequities that exist between cultural groups.

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Section: Discussionmentioning

confidence: 99%

Developing cultural competence in general practitioners: an integrative review of the literature

2016

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“…Rather, a great deal of learning occurs outside of the classroom representing an informal curriculum operating in a predominantly ad-hoc manner. The hidden curriculum or 'the set of influences that function at the level of organisational structure and culture' (Ewen, Mazel, & Knoche, 2012, p. 201) may also play a role in creating and maintaining an environment that employs or fails to develop teaching staff who are able to assess the Hauora Māori 4 Domain (Ewen et al, 2012). This is a particular challenge for health faculties given their reliance on clinical educators who are not university employees and often lack formal training in educational techniques yet are involved in teaching of students in clinical settings (Jaye, Egan, Smith-Han, & ThompsonFawcett, 2009;Krueger et al, 2004).…”

Section: Undergraduate Programmementioning

confidence: 99%

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

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et al. 2014

Higher Education Research & Development

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Tertiary institutions aim to provide high quality teaching and learning that meet the academic needs for an increasingly diverse student body including indigenous students. Tā tou Tā tou is a qualitative research project utilising Kaupapa Mā ori research methodology and the Critical Incident Technique interview method to investigate the teaching and learning practices that help or hinder Mā 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 Mā ori student success. Thirteen sub-themes were grouped into three overarching themes representing potential areas of focus for tertiary institutional undergraduate health programme development: Mā ori student support services, undergraduate programme, and Mā 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.

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“…Training which promotes cultural competence can be undervalued throughout medical training, influenced by a hidden curriculum in which biomedical knowledge is the key to success [21]. Teaching and supervising communication and consultation skills as well as medical competence are core and explicit roles of the GP Supervisor and Medical Educator.…”

Section: Discussionmentioning

confidence: 99%

General Practitioner Supervisor assessment and teaching of Registrars consulting with Aboriginal patients – is cultural competence adequately considered?

et al. 2014

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BackgroundGeneral Practitioner (GP) Supervisors have a key yet poorly defined role in promoting the cultural competence of GP Registrars who provide healthcare to Aboriginal and Torres Strait Islander people during their training placements. Given the markedly poorer health of Indigenous Australians, it is important that GP training and supervision of Registrars includes assessment and teaching which address the well documented barriers to accessing health care.MethodsA simulated consultation between a GP Registrar and an Aboriginal patient, which illustrated inadequacies in communication and cultural awareness, was viewed by GP Supervisors and Medical Educators during two workshops in 2012. Participants documented teaching points arising from the consultation which they would prioritise in supervision provided to the Registrar. Content analysis was performed to determine the type and detail of the planned feedback. Field notes from workshop discussions and participant evaluations were used to gain insight into participant confidence in cross cultural supervision.ResultsSixty four of 75 GPs who attended the workshops participated in the research. Although all documented plans for detailed teaching on the Registrar’s generic communication and consultation skills, only 72% referred to culture or to the patient’s Aboriginality. Few GPs (8%) documented a plan to advise on national health initiatives supporting access for Aboriginal and Torres Strait Islander people. A lack of Supervisor confidence in providing guidance on cross cultural consulting with Aboriginal patients was identified.ConclusionsThe role of GP Supervisors in promoting the cultural competence of GP Registrars consulting with Aboriginal and Torres Strait Islander patients could be strengthened. A sole focus on generic communication and consultation skills may lead to inadequate consideration of the health disparities faced by Indigenous peoples and of the need to ensure Registrars utilise health supports designed to decrease the disadvantage faced by vulnerable populations.

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Exposing the Hidden Curriculum Influencing Medical Education on the Health of Indigenous People in Australia and New Zealand

Cited by 33 publications

References 25 publications

Developing cultural competence in general practitioners: an integrative review of the literature

Developing cultural competence in general practitioners: an integrative review of the literature

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

General Practitioner Supervisor assessment and teaching of Registrars consulting with Aboriginal patients – is cultural competence adequately considered?

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