Te Ara: A pathway to excellence in indigenous health teaching and learning

1. Te Ara: A pathway to excellence in indigenous health teaching and learning Dr Rhys Jones Te Kupenga Hauora Māori University of Auckland, New Zealand LIME Connection III, Melbourne, 3 Dec 2009

2. Background • The Faculty of Medical and Health Sciences (FMHS) at the University of Auckland has recently adopted Te Ara, a common graduate profile in Māori health for Medicine, Nursing, Pharmacy and Health Sciences

3. Why a Māori health graduate profile?

4. Why a Māori health graduate profile? • All FMHS programmes have learning components related to Hauora Māori (Māori health) • To date the development of these components has been somewhat opportunistic • The vision for graduate outcomes in Hauora Māori has never been fully articulated

5. Previous model • Back seat driver • Irritating, but ultimately have very little influence over where we’re going

6. New model • Graduate Profile Strategy (GPS) • We have set the destination • Can provide guidance on how to get there

7. What are the expected benefits? • Enable the FMHS to articulate a shared vision for Hauora Māori • Promote alignment and consistency of Māori health teaching, learning and assessment • Identify and address gaps in the curricula • Allow sharing of ‘best practice’ across undergraduate programmes

8. Developing Te Ara • Principles • Collaborative approach • Evidence-based • Acknowledges and builds on existing work • Flexible, to allow for specific needs of programmes • Methods • Audit of current teaching • Literature review and expert advice • Senior academic panel review • Consultation with undergraduate programme leaders

9. Graduate learning outcomes

10. Graduate learning outcomes • In respect to Hauora Māori, graduates of the FMHS will be able to: • Engage appropriately in interactions with Māori individuals, whānau and communities • Explain the historic, demographic, socioeconomic, and policy influences on health status • Explain how ethnic inequalities in health are created and maintained and how they may be reduced and eliminated • Identify approaches to reducing and eliminating inequalities including actively challenging racism

11. Graduate learning outcomes, cont. • In respect to Hauora Māori, graduates of the FMHS will be able to: • Explain the influence of one’s own culture and that of the health system on patient and population health outcomes • Engage in a continuous process of reflection on one’s practice and actively participate in self-audit in respect of the Treaty of Waitangi • Identify and address professional development needs as a basis for life-long learning about Māori health

12. Organising the Hauora Māori Curriculum

13. Hauora Māori fields • Mana Taketake - Indigenous Issues • Te Iwi Māori - Population • Tikanga Whakaruruhau - Quality and Safety • Tikanga Kawa - Practice Source: NZ History Online. ‘All in a day's work - living in the 20th century’.

14. Mana Taketake – Indigenous Issues • Indigenous Rights • Treaty of Waitangi • Introduction to Te Ao Māori (the Māori world)

15. Te Iwi Māori - Population • Ethnicity and ancestry • Demography • Māori health status • The determinants ofinequality Source: Robson B, Harris R. (eds). 2007. Hauora: Māori Standards of Health IV. A study of the years 2000-2005. Wellington: Te Rōpū Rangahau Hauora a Eru Pōmare. Available at www.hauora.maori.nz/hauora/

16. Tikanga Whakaruruhau –Quality and Safety • Cultural competence • Racism • Interprofessional practiceand learning • Self-reflection Source: Jones CP. Invited commentary: “race,” racism, and the practice of epidemiology. American Journal of Epidemiology. 2001; 154(4): 299-304.

17. Tikanga Kawa - Practice • Communication • Self-audit • Research • Lifelong learning Source: Curtis E. The colour of your heart: an analysis of ethnic disparities in invasive cardiovascular procedure use between Māori and non-Māori in New Zealand [unpublished Masters dissertation]. Wellington, N.Z.: Wellington School of Medicine, 2002.

18. Implementation of Te Ara

19. Process for implementation • Support programmes to map curricula against Te Ara • Identify areas that requiredevelopment • Identify the professionaldevelopment and resourceneeds of each programme • Develop curricula toensure teaching, learningand assessment are aligned with Te Ara

20. Examples of current/future work • Year 1 Population Health course • Māori Health Week (Interprofessional Year 2) • Year 4 Māori health teaching • Development of teaching & learning resources • Including online resource for staff • Research into assessment of Māori health in clinical settings • International collaborative research?

21. Challenges ahead

22. Challenge 1: Integration • The major approach to Māori health teaching has been in dedicated blocks or courses • But learning is more powerful if it happens in context • The challenge is to get HauoraMāori teaching and learningcloser to where the rubberhits the road

23. Challenge 2: Capacity • Many teachers currently feel unprepared to teach and assess Māori health • How do we build capacity throughout the Faculty for Māori health teaching, learning and assessment?

24. Challenge 3: Logistics • Curricula are already jam-packed • How can we ensure that Māori health learning outcomes can be met: • without unduly adding to students’ teaching and assessment load? • without ghettoising or demonising Māori health?

25. Acknowledgments • Papaarangi Reid & Barbara O’Connor • Programme leaders from Medicine, Nursing, Pharmacy and Health Sciences • Mark Barrow, Associate Dean (Education) • Iain Martin, Dean