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

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.

Review article: Implicit bias towards Aboriginal and Torres Strait Islander patients within Australian emergency departments

“…Aboriginal community‐controlled health services have proven to provide more equitable, higher‐quality care to Indigenous Australians 6 . It would also provide opportunity to establish meaningful patient‐provider relationships that challenges any pre‐conceived biases or assumptions, both conscious and unconscious, about Aboriginal and Torres Strait Islander people 48 …”

“…6 It would also provide opportunity to establish meaningful patient-provider relationships that challenges any preconceived biases or assumptions, both conscious and unconscious, about Aboriginal and Torres Strait Islander people. 48 Individual physicians are not inherently at fault for their implicit bias, nor should blame be placed against individuals. However, physicians do have a responsibility to be aware of and actively engaged in efforts to reduce racial disparities in healthcare.…”

Healing Conversations: Developing a Practical Framework for Clinical Communication Between Aboriginal Communities and Healthcare Practitioners

“…In light of this ongoing struggle there is increasing recognition within the health community to advance and enable best practice care provision for Aboriginal peoples [7,8]. This is on a background of international evidence demonstrating a lower quality of healthcare provision for ethnic and minority groups across the globe [9].…”

“…This is in recognition of the importance of place-based care; health care that is considerate of the local priorities, expectations and ways of being of the community served. [7] A focus on literature detailing knowledges from Central Australia, South Australia and North Western Australia guide the following domain considerations.…”

From organisations to people: improving the prevention and management of long-term conditions in Australian primary health care

“…Four principles of medical professionalism in the context of care for Aboriginal and Torres Strait Islander people were identified from a study of the learning experiences of medical students and registrars by Askew et al (2017). Despite being a requirement for Australian health services, Kwedza et al (2017) found that clinical governance is poorly understood by people working in rural and remote primary care.…”