History of the LIME Network and the development of Indigenous health in medical education

Haynes, Timothy M; Collins, Margo E; Mazel, Odette; Lawler, Louise M A; Ryan, C. C.; Ewen, Shaun

doi:10.5694/mja13.10403

Cited by 10 publications

(5 citation statements)

References 17 publications

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“…There have been significant recent advances in the emerging discipline of Indigenous health in medical education 20–23 and in frameworks for designing Indigenous health curricula. 24–26 Despite these developments and the acknowledged challenges in determining causal associations, 27 there is limited evidence that medical education initiatives have effectively translated into improved health outcomes for Indigenous populations or a reduction in disparities.…”

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confidence: 99%

Educating for Indigenous Health Equity: An International Consensus Statement

et al. 2019

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The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence—for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role and, in fact, may be complicit in perpetuating inequities. This article seeks to examine the factors underpinning medical education’s role in Indigenous health inequity, to inform interventions to address these factors. The authors developed a consensus statement that synthesizes evidence from research, evaluation, and the collective experience of an international research collaboration including experts in Indigenous medical education. The statement describes foundational processes that limit Indigenous health development in medical education and articulates key principles that can be applied at multiple levels to advance Indigenous health equity. The authors recognize colonization, racism, and privilege as fundamental determinants of Indigenous health that are also deeply embedded in Western medical education. To contribute effectively to Indigenous health development, medical education institutions must engage in decolonization processes and address racism and privilege at curricular and institutional levels. Indigenous health curricula must be formalized and comprehensive, and must be consistently reinforced in all educational environments. Institutions’ responsibilities extend to advocacy for health system and broader societal reform to reduce and eliminate health inequities. These activities must be adequately resourced and underpinned by investment in infrastructure and Indigenous leadership.

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confidence: 99%

Educating for Indigenous Health Equity: An International Consensus Statement

et al. 2019

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“…The most notable and comprehensive approach to the inclusion of Aboriginal health in the accreditation standards and related activity can be seen in medical education. 6 , 7 Much of the curriculum development response has been to include Aboriginal examples to highlight particular diseases for which the Aboriginal population carries a specific high burden, such as diabetes. This approach was driven in part by the widespread use of problem-based learning (PBL) in medical education, despite serious concerns for its effectiveness in strengthening students’ knowledge base and maximizing clinical performance.…”

Section: Resultsmentioning

confidence: 99%

"Unwell while Aboriginal": iatrogenesis in Australian medical education and clinical case management

Ewen¹,

Hollinsworth²

2016

AMEP

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IntroductionAttention to Aboriginal health has become mandatory in Australian medical education. In parallel, clinical management has increasingly used Aboriginality as an identifier in both decision making and reporting of morbidity and mortality. This focus is applauded in light of the gross inequalities in health outcomes between indigenous people and other Australians.MethodsA purposive survey of relevant Australian and international literature was conducted to map the current state of play and identify concerns with efforts to teach cultural competence with Aboriginal people in medical schools and to provide “culturally appropriate” clinical care. The authors critically analyzed this literature in light of their experiences in teaching Aboriginal studies over six decades in many universities to generate examples of iatrogenic effects and possible responses.Results and discussionUnderstanding how to most effectively embed Aboriginal content and perspectives in curriculum and how to best teach and assess these remains contested. This review canvasses these debates, arguing that well-intentioned efforts in medical education and clinical management can have iatrogenic impacts. Given the long history of racialization of Aboriginal people in Australian medicine and the relatively low levels of routine contact with Aboriginal people among students and clinicians, the review urges caution in compounding these iatrogenic effects and proposes strategies to combat or reduce them.ConclusionLong overdue efforts to recognize gaps and inadequacies in medical education about Aboriginal people and their health and to provide equitable health services and improved health outcomes are needed and welcome. Such efforts need to be critically examined and rigorously evaluated to avoid the reproduction of pathologizing stereotypes and reductionist explanations for persistent poor outcomes for Aboriginal people.

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“…The implementation phase of curriculum change can be protracted despite the in-principle support for new frameworks [ 4 ]. However, as demonstrated by the Leaders in Indigenous Medical Education (LIME) Network, established to support the implementation of an Indigenous Health Framework in Australian medical schools, strategies can be developed over time that encourage and support implementation [ 18 ]. While this study demonstrates that medical schools support the notion of men’s health learning, an innovative approach to curriculum enhancement may be required to minimise the potential resourcing barriers to implementation.…”

Section: Discussionmentioning

confidence: 99%

“Men’s health – a little in the shadow”: a formative evaluation of medical curriculum enhancement with men’s health teaching and learning

et al. 2015

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BackgroundEnhancing a medical school curriculum with new men’s health teaching and learning requires an understanding of the local capacity and the facilitators and barriers to implementing new content, and an approach that accommodates the systemic and cultural differences between medical schools.MethodsA formative evaluation was undertaken to determine the perspectives of key informants (academics, curriculum developers) from four Australian medical schools about the strategies needed to enhance their curriculum with men’s health teaching and learning. Through semi-structured questioning with 17 key informants, interviewees also described the contextual barriers and facilitators to incorporating new topic areas into existing curriculum. Interviews were recorded with consent, transcribed verbatim, and analysed by two researchers to identify key themes.ResultsInterviewees were enthusiastic about incorporating men’s health content through a men’s health curriculum framework but highlighted the need for systems to assist in identifying gaps in their current curriculum where the men’s health topics could be integrated. The student experience was identified as a key driver for men’s health teaching and learning. Furthermore, core men’s health clinical outcomes needed to be defined and topic areas vertically integrated across the curricula. This would ensure that students were appropriately equipped with the skills and knowledge for subsequent clinical practice in a range of geographical settings. Interviewees consistently suggested that the best implementation strategy is to have someone ‘on the ground’ to work directly with medical school staff and champion the men’s health discipline. Providing mechanisms for sharing knowledge and resources across medical schools was highlighted to facilitate implementation, particularly for those medical schools with limited men’s health teaching resources.ConclusionsDespite the unanimous support for men’s health teaching and learning, the evaluation highlighted that the student experience must be recognised as paramount when integrating new topic areas into an already packed curriculum. A community of practice, where medical schools share relevant resources and knowledge, could help to ensure a commonality of student experience with respect to men’s health learning in medical schools across different geographical settings and with different levels of resourcing. Such an approach could also be adapted to other areas of curriculum enhancement.

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History of the LIME Network and the development of Indigenous health in medical education

Cited by 10 publications

References 17 publications

Educating for Indigenous Health Equity: An International Consensus Statement

Educating for Indigenous Health Equity: An International Consensus Statement

"Unwell while Aboriginal": iatrogenesis in Australian medical education and clinical case management

“Men’s health – a little in the shadow”: a formative evaluation of medical curriculum enhancement with men’s health teaching and learning

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History of the LIME Network and the development of Indigenous health in medical education

Cited by 10 publications

References 17 publications

Educating for Indigenous Health Equity: An International Consensus Statement

Educating for Indigenous Health Equity: An International Consensus Statement

&quot;Unwell while Aboriginal&quot;: iatrogenesis in Australian medical education and clinical case management

“Men’s health – a little in the shadow”: a formative evaluation of medical curriculum enhancement with men’s health teaching and learning

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"Unwell while Aboriginal": iatrogenesis in Australian medical education and clinical case management