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Cultural Competencies in Medical Training
Refer Attachment 2
Dr Catherine Engelke - experiences in medical school
  • Nurse & Midwife in the Kimberley, before studying Medicine
  • Works in a remote clinic 2 days a fortnight; many people come to see the Aboriginal doctor Talk, tell stories, see her as a doctor
  • AMS – is culturally appropriate, culturally safe
  • In the Healthcare system people are caring but many missed the point; suggested other ways of doing things
Cultural Competence Continuum
  • Cultural Destructiveness eg Stolen Generation
  • Cultural Incapacity eg: lice checks different for aboriginal kids and white kids
  • Cultural Blindness eg: Princess Margaret Hospital, nurses believing an Aboriginal mother was neglectful of her 18 mth old baby in hospital, while not understanding that she had 4 other children to care for at home and believed her baby was being well looked after
  • Cultural Pre-competence eg: token Aboriginal person in workforce – employing an Aboriginal Health Worker, but not educating staff at the hospital about their skills (as competent as an EN or RN)
  • Cultural Competency eg: Remote Clinic Pap-athon – run over 3 days with different age groups on each day so that young women do not feel uncomfortable sitting in the waiting room with their mothers and grandmothers
  • Cultural Proficiency – still long way to go, still learning

Assoc Prof Clive Walley - what Cultural Competencies do we want in our students?

  • Distinguish between Aboriginal and Torres Strait Islander people
  • Start developing relationships
  • Good doctors / Principled approach / Include community perspectives
  • Experiential Learning - Rural, remote and urban immersion
  • Work with allied health professionals – colleagues
  • Understand language groups / kinship groups
  • Strong sense of professionalism and social responsibility
  • Learn from mistakes
Prof Lyn Henderson-Yates – How important is institutional governance in the attainment of these competencies? A regional university perspective
  • Important for Universities to mandate cultural competencies - Secures integration in delivery of program
  • Graduates competent to practice medicine and work with ATSI people
  • Listen, understand, practice compassion and commitment
  • Respond to health needs of ATSI people
  • 47.7 % of the population of the Kimberley are Aboriginal; 200 communities, 34 languages
  • Serious disadvantage and health issues / Unmet health needs
  • Treating using western methods alone won’t improve Aboriginal health
  • Central to improving health is Aboriginal culture - Ngarlu – treat whole person

Professor Sarah Strasser - Assoc Dean Flinders NT - the experience in other medical schools

  • NT program is what success is all about
  • Positive affirmation for Indigenous students
  • Aboriginal Health in the NT is mainstream

Fiona Pacey – Faculty Manager, University of Western Sydney - The experience in other medical schools

  • Rural program and Indigenous health placement developed alongside the course
  • Wonderful and exciting being involved in a community
  • Family structures / history and policy and how influences health
  • Treat person not the issue; allow patients time to tell their story

Panel discussion: what policy changes are needed to progress cultural competencies in RCSs?

Key Points

  • Speak up when see people missing the point
  • Acknowledge diversity of Aboriginal and Torres Strait Islander people / dangers of stereotypes
  • Graduates should be able to work in all forms of health care in culturally appropriate way
  • Importance of treating the whole person – mental, physical, spiritual health - Ngarlu