From CDAMS to classroom

2. From CDAMS to classroom Dr Lilon Bandler Senior Lecturer; Indigenous Health Education Unit Sydney Medical School

3. CDAMS • History • … in the hope that we may have a lasting positive impact on the health of the First Australians … and by extension, the well-being of the nation.

4. Australian Medical Council • national standards body for medical education and training • assesses medical school courses • Set standards • knowledge, skills and professional attributes expected on graduation • How education and training should be provided

5. 2007, AMC accreditation standards • explicit focus on Indigenous health • Indigenous health as a curriculum topic • students’ experience in providing health care to Indigenous people • processes, settings and resources • Australian Aboriginal & Torres Strait Islander, New Zealand Maori students • Admission • Recruitment • Support

6. CDAMS Indigenous Health Curriculum Framework • Guiding principles • Suggested subject areas; Key student attributes & outcomes • Pedagogical principles and approach • Delivery and assessment • Suggested process for curriculum development • Resources, capacity and workforce development issues

7. University of Sydney • Faculty of Medicine • Sydney Medical School • 1868 assassination attempt • March 1883 • four students • four-roomed cottage • 2009 • 380 first year medical & dentistry students

8. Sydney Medical School • Graduate entry • GPA • GAMSAT • Multiple mini interviews • Four year • PBL model

9. Senior lecturerin Indigenous health education • July 2006 … to • Increase numbers & support existing Indigenous medical students • Community … clinical placements • Review and develop teaching & learning resources in Indigenous health

11. Implementation of CDAMS • Translation – locality • Pre-existing • Course structure … process • Content

12. Curriculum review • Timely • Re-configuring • PBL • Complex • Linked • Indigenous health

13. Sydney Medical Program • Learning objectives • CDAMS • SMP • Scope • No prior awareness • Core • Specialise

14. Process … Stage 1 & 2 • 2 yrs on campus • Face to face • Resources • Web • Small group learning • Formal presentations • Practical clinical sessions • Others …

15. Process … PBL • Clinical problem • Pivot – challenging, open ended • Collaborative • Reflective • Responsibility • Development of skills • Communication • Problem-solving • Self-directed learning

16. Stage 1 … content • PBLs • Lectures, theme sessions, covering • Population, M&M • History • Chronic disease • Healthcare delivery initiatives • Successes • Difficulties • Application • Social determinants of health • International comparisons

17. Mrs Newman … • Developed in response to • Place in Stage 1 … Foundation Block • PBL process • Concerns from clinicians • Chronic disease • Cardiovascular disease

18. Mrs Newman … Assessment in ED DD chest pain, GIT pathology Emergency management • Mrs Joyce Newman presents to the Emergency Department with 4½ hours of discomfort in her chest. She thinks she has indigestion. However the pain/discomfort is worsening, and now radiates into her neck and jaw. This has prompted her presentation. • 37 year old Aboriginal woman • Three children • Triage level 4 • potentially serious • to be seen within 1 hour Indigenous health Triage

19. Associated material • Fixed didactic • PBL tutorials

20. Associated T&L resources • PBL tutorials • Tutor briefing sheet • Tutor meeting • Comprehensive medical history • Family tree • Triage • Mechanism diagram

21. Associated T&L resources

22. Associated T&L resources

23. Associated T&L resources • Learning topics: anatomy, pain, arterial disease, treatment adherence, hypoxia, coronary artery disease in Australian Aborigines and Torres Strait Islanders • Lectures • Anatomy, biochem, pharm, radiology … • References: ECGs, anatomy, ED guidelines for ACS management, triage

24. Subsequently … • Stage 2 • Development of cultural training • Stage 3 • Clinical rotations • PNW • Community • Psychological medicine; D&A • Paediatrics

25. Stage 3 year 4community rotation • Discharge to the community • Follow-up • Communication with AMS, AHWs, GP • Financial matters • Access to healthcare • Health promotion

26. Specialising … opportunities • Stages I & 2 • Independent learning activities • Campus • Dubbo • Broken Hill UDRH • Northern Rivers UDRH • Rural placements • Stage 3 • Honours • Electives

27. Assessment • Drives • Essays • SBAs • Student engagement • Student thinking

28. Evaluation • Part of SMS • Routine EOY qq • Clinical school • Questions

29. Evaluation • understanding of the history, cultural development and health of Indigenous people of Australia • clinical experience

30. Feedback • Students • Faculty • Block review • Emphasis on mechanism • Not too hard • Review of group dynamics

31. LEARNING OBJECTIVES

32. Alignment • Learning objectives • T&L resources • Assessment • Extension opportunities • Evaluation & review

33. Sydney Medical Program • Indigenous stream throughout the course • Guided by • CDAMS • Learning objectives • Clinical placements • Within the program • Core • Extension opportunities • Embedded • Engaged students

34. Bibliography … links … • Phillips G (2004) Committee of Deans of Australian Medical Schools Indigenous Health Curriculum Frameworkhttp://www.limenetwork.net.au/content/curriculum-framework • Australian Indigenous HealthInfoNet: www.healthinfonet.ecu.edu.au