Healing conversations: Developing a practical framework for clinical communication between Aboriginal communities and healthcare practitioners

In recognition of the ongoing health disparities experienced by Aboriginal and Torres Strait Islander peoples (hereafter Aboriginal), this scoping review explores the role and impact of the clinical communication process on Aboriginal healthcare provision. A medical education lens is applied, looking at the utility of a tailored clinical communication framework to assist health practitioners work more effectively with Aboriginal peoples and communities. The initial framework, building on existing communication guides, proposes four domains: content, process, relational and environmental. It places emphasis on critical self-reflection of the health practitioner’s own cultural identity and will be guided by collective Aboriginal world-views in select Australian settings. Using a two-eyed seeing approach the framework will be developed and tested in health professional education. The aim of this research journey is to enable health practitioners to have more effective healthcare conversations with Aboriginal peoples, working toward more socially just and equitable healthcare interactions and outcome

Healing Conversations: developing a practical framework for clinical communication between Aboriginal patients, their families and healthcare practitioners

Introduction: This Healing Conversations project aims to contribute to building culturally capable healthcare practitioners skilled in effective communication with Aboriginal peoples and their families. To achieve this, the research has developed a communication framework for use in healthcare curricula. The conceptual notion of two-eyed seeing, or Etuaptmumk, put forth by Mi'kmaw elders Albert and Murdena Marshall has guided implementation of the research. This approach values Indigenous and non- Indigenous perspectives and recognises the importance of Indigenous governance in the research process. Ontological and methodological approach: A qualitative approach was implemented to gain in depth understandings of key stakeholders. An initial framework, developed from the literature to form the basis of data collection, was refined in response to findings from the research data. Data collection consisted of: (1) semi-structured interviews with Aboriginal community members and registered healthcare practitioners in South Australia (SA) and Western Australia (WA); (2) a workshop with a health education academic and an Aboriginal community member from SA, and two medical students (from SA and WA). Ethics approval for this research was obtained from the Adelaide University human research ethics committee, the South Australian Aboriginal health ethics committee, the Western Australian Aboriginal Health Ethics Committee, and the University of Notre Dame Australia human research ethics committee and Community organisational support has been provided by Pika Wiya Health service, Nunkuwarrin Yunti Aboriginal health service and Kimberley Aboriginal Health Planning Forum. Key findings: Four key themes emerged from the interviews: building the therapeutic relationship; communication in the clinical encounter; institutional and organisational factors impacting communication; and educating healthcare practitioners in communication. These results acknowledged that communication approaches need to be patient-centred, considerate of Indigenous worldviews and guided by geographical and community contexts. The workshop validated the interview findings, recognising the Framework encompassed a broad range of cultural capabilities and required a scaffolded approach to curriculum development and implementation. The workshop highlighted the importance of quality, well-resourced teaching and assessment of Indigenous health in healthcare curricula. Discussion: The targeted communication Framework was developed in stages in response to different avenues of feedback from Aboriginal community members, healthcare practitioners and medical students. Implementing the Framework in healthcare curricula will require close consideration to effective approaches to knowledge translation in Aboriginal health. This can include learning on Country experiences as well as supported clinical exposure, the inclusion of diverse perspectives in curricula and ensuring effective and meaningful assessment opportunities for students to demonstrate learning and identify knowledge deficiencies. This has important implications for the resourcing and governance of Indigenous health curricula. Conclusion and future directions: Healing Conversations presents a Framework for use in healthcare professional education to better prepare students to communicate effectively with Aboriginal patients and their families (figure 1). Applying this Framework into tertiary health professional education can assist with decolonising health education academies and Indigenising health professional education. The use of the Framework in medical education and post-graduate training will provide a platform for further nuanced research into the educational impact on cultural capability outcomes for healthcare practitioners.Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 202

Recreating the future - Indigenous research paradigms in health professional education research

Introduction: Health and self-determination are recognised as universal human rights. Health professional education research and practice hold the capacity to prioritise values, worldviews and agendas that envisage sustainable and equitable futures for the entire community served. This paper explores the need for the co-location of Indigenous research paradigms in health professional education research and teaching. Indigenous communities have a long history of science, research and sustainable living and are holders of ways of knowing, being and doing that can shape actions and priorities in health research that value equity and sustainability. Discussion: Knowledge construction in health professional education research does not occur in isolation nor is it value neutral. A continued dominance of the biomedical approach to health creates a system of innovation that is unbalanced and unable to deliver health outcomes demanded by contemporary society. As power and hierarchies are embedded in health professional education research and praxis, transformative action is required to bring forth marginalised voices in research processes. Critical reflexivity regarding the ontological, epistemological, axiological and methodological positioning of researchers is an important step towards creating and sustaining research structures that effectively value and co-locate different perspectives in knowledge production and translation. Conclusion: Working towards more equitable and sustainable futures for Indigenous and non-Indigenous communities requires health care systems to be informed and guided by different knowledge paradigms. This can work to avoid the ongoing reproduction of inefficient biomedical structures and purposefully disrupt the status quo of health inequities. Realising this requires the effective co-location of Indigenous research paradigms and ways of working into health professional education research that centre relationality, wholism, interconnectedness and self-determination. This calls for a raising of the critical consciousness of health professional education research academies

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

In recognition of the ongoing health disparities experienced by Aboriginal and Torres Strait Islander peoples (hereafter Aboriginal), this scoping review explores the role and impact of the clinical communication process on Aboriginal healthcare provision. A medical education lens is applied, looking at the utility of a tailored clinical communication framework to assist health practitioners work more effectively with Aboriginal peoples and communities. The initial framework, building on existing communication guides, proposes four domains: content, process, relational and environmental. It places emphasis on critical self-reflection of the health practitioner\u27s own cultural identity and will be guided by collective Aboriginal worldviews in select Australian settings. Using a two-eyed seeing approach the framework will be developed and tested in health professional education. The aim of this research journey is to enable health practitioners to have more effective healthcare conversations with Aboriginal peoples, working toward more socially just and equitable healthcare interactions and outcomes

The role of governance in Indigenous medical education research

Context: This article considers the role of governance in Indigenous medical education research through the lens of an Australian Aboriginal research project titled Healing Conversations. The Healing Conversations project is developing and testing a targeted educational framework for improved clinical communication between healthcare practitioners and Australian Aboriginal peoples in regional and urban locations. It is proposed that an effective governance approach can support Indigenous and non-Indigenous stakeholders to work together in decisionmaking structures to enable outcomes that promote and prioritise Indigenous worldviews and values in medical education research. Issue: The case study explored here puts forth the notion of effective governance as one practical way to decolonise medical education research structures in both the urban and regional setting. The importance of relationships between Indigenous and non-Indigenous stakeholders is supported in tailored governance structures, as knowledge translation efforts are situated in mainstream tertiary education structures that hold collective responsibility and accountability for change in this space. Lessons learnt: Reflections from the Healing Conversations research case study are outlined for future consideration regarding sustainable and effective Indigenous governance initiatives in medical education and research structures. This includes the importance of an Indigenous governance structure within the research team and a strong understanding of the roles and contributions of each research team member, along with the required humanistic qualities to action effective governance in Indigenous medical education research. Collaborative governance structures are fundamental as the inclusion and prioritisation of Indigenous worldviews and values is a key step in redressing Indigenous healthcare disparities and providing culturally safe healthcare institutions