A bridge between: Te Ao Māori and Te Ara Paerangi

Purpose Aotearoa New Zealand’s Research, Science and Innovation (RSI) system is undergoing a ‘once in a generation’ reform known as Te Ara Paerangi Future Pathways (TAP). One of TAP’s four high-level goals is to embed Te Tiriti o Waitangi across the RSI system. Using the analogy of bridge-making, we draw on insights from Māori submissions to TAP to identify collective Māori expectations for what a Tiriti-embedded system entails. Method Submissions were accessed through the document library on the Ministry of Business, Innovation and Employment website. 34 submissions from individuals and collectives were identified as Māori. Qualitative Document Analysis was used to identify major themes. Results Results are described with reference to basic bridge-building principles of design, foundations, materials and maintenance. Key thematic findings include: Māori, as Tiriti partners, must be meaningfully involved in the reform design; the RSI system’s foundations are deeply colonial - decolonisation is needed to value, respect and protect Māori knowledges and knowledge-holders; workforce development, infrastructure and policies are required to empower partnered and autonomous RSI approaches; and, ongoing system maintenance in the form of monitoring is required to ensure transparency, accountability and equitable benefits. Reflection Having committed to embedding Te Tiriti across the RSI system, MBIE now has a duty of care to deliver on its commitment vis-à-vis the National Research Priorities. This paper is a timely opportunity to set a baseline of collective expectations against which to assess the future efficacy of TAP. Ka mahi mātou, me te takune hei puananī We will work with the intent to travel freely in any directio

Curricular initiatives that enhance student knowledge and perceptions of sexual and gender minority groups: a critical interpretive synthesis

Background: There is no accepted best practice for optimizing tertiary student knowledge, perceptions, and skills to care for sexual and gender diverse groups. The objective of this research was to synthesize the relevant literature regarding effective curricular initiatives designed to enhance tertiary level student knowledge, perceptions, and skills to care for sexual and gender diverse populations.Methods: A modified Critical Interpretive Synthesis using a systematic search strategy was conducted in 2015. This method was chosen to synthesize the relevant qualitative and quantitative literature as it allows for the depth and breadth of information to be captured and new constructs to be illuminated. Databases searched include AMED, CINAHL EBM Reviews, ERIC, Ovid MEDLINE, Ovid Nursing Database, PsychInfo, and Google Scholar. Results: Thirty-one articles were included in this review. Curricular initiatives ranging from discrete to multimodal approaches have been implemented. Successful initiatives included discrete sessions with time for processing, and multi-modal strategies. Multi-modal approaches that encouraged awareness of one’s lens and privilege in conjunction with facilitated communication seemed the most effective.Conclusions: The literature is limited to the evaluation of explicit curricula. The wider cultural competence literature offers further insight by highlighting the importance of broad and embedded forces including social influences, the institutional climate, and the implicit, or hidden, curriculum. A combined interpretation of the complementary cultural competence and sexual and gender diversity literature provides a novel understanding of the optimal content and context for the delivery of a successful curricular initiative

Te Aka Roa o Te Oranga, the far reaching vines of wellness: The development of a framework to evaluate alcohol and drug treatment for Māori

The impact of alcohol and other drug problems for Māori is well documented. Substance use has been implicated in a range of physical and mental health problems, and a variety of negative social statistics such as high rates of imprisonment. To date there has been little systematic documentation of treatment practices, and limited operationalisation of Māori health frameworks. The evaluation of the outcomes of alcohol and other drug treatments is an area in which there is a paucity of documentation, in terms of methods and frameworks for evaluation, and actual data. Te Aka Roa O Te Oranga (TAROTO) was developed from a range of projects undertaken by the National Addiction Centre. The TARATO evaluation framework embraces a holistic perspective: developed to examine the interaction between the client, whānau, practitioner, and service/organisation. The aim of the framework is to clarify the complex relationships and interactions between stakeholders within the context of treatment. It will also help to elucidate the strengths and weaknesses of individual services. Within this framework, a range of indicators and outcomes of “successful treatment” will be explored. The current project is the first phase of a broader project that will make a significant contribution to improvements in Māori health via further developing effective treatments of alcohol and other drug related problems

Stakeholders’ Perspectives on the Quality of End-of-Life Health Care Services for Chronic Obstructive Airways Disease: A Focus Group Study

Introduction: Delivery of end-of-life care for severe chronic obstructive pulmonary disease (COPD) has been hampered by an unpredictable disease trajectory and poor integration of health care and social services. Objective: To critically explore the perspectives, values, and experiences of stakeholders in COPD end-of-life healthcare services in a large district in Aotearoa New Zealand. Design: Focus groups analysed utilising critical theory and Actor-Network Theory. Methods: Stakeholders in end-of-life COPD healthcare services were purposively sampled from a large healthcare network in Canterbury, Aotearoa New Zealand to participate in seven focus groups (bereaved carers, community-based health professionals, non-Māori, non-Pacific patients, and support people (two groups), Māori patients, supporters and health professionals, Pacific patients, support people and health professionals, and hospital-based health professionals). Participants discussed end-of-life care services for people with COPD. Transcripts were coded utilising descriptive and structural coding to develop themes related to provision of quality care. Participants were positioned as experts. We considered how the themes arising supported and disrupted the healthcare network for end-of-life COPD. Results: Five themes related to quality of care for end-of-life COPD were identified: compassion, competence, community, commitment, and collaboration. The absence of any of these five themes required for quality care led to power imbalances within healthcare systems. Power inequities created disconnection among stakeholders which then disrupted commitment, community, and collaboration. A dysfunctional healthcare network impeded compassion between stakeholders and did not support their competence, leading to lower quality care. All five themes were identified as essential to delivery of high-quality end-of-life care in COPD. Conclusion: Stakeholders’ perspectives of end-of-life care for COPD identified of core features of a health system network that enabled or impeded the actions of stakeholders and allocation of resources to provide quality care

Rauaroha: He tohu Aroha rau i te akoranga

Nö te tau 2001 i whakatüria ai e Ako Aotearoa (National Centre for Tertiary Teaching Excellence) tëtahi tohu hei whakanui i ngä mahi a te tangata e whakaako ana i te taumata takiura. Me whakaatu te kaiwhiwhi tohu i tana ü roa ki ngä taumata tiketike rawa i tana mahi whakaako. Tekau mä rua ngä kaiwhiwhi toa i ia tau, kätahi ka whiriwhirihia ai e tëtahi kömiti kaiwhakawä kia kotahi te tangata e whiwhi nei i te Tohu Tiketike o te Pirimia. Mö ngä tau e whä kua hipa ake nei i riro i ngä kaiako Mäori te tohu tiketike nei. Ko te aronga o tënei tuhinga he whakaatu i ngä ähuatanga o ënei kaiako kia märama pai atu ai te whakaaro tiketike o te Mäori ki tënei mea te ako

Educating for Indigenous health equity: An international consensus statement

The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence, for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role, and in fact may be complicit in perpetuating inequities. This article seeks to examine the factors underpinning medical education’s role in Indigenous health inequity, in order to inform interventions to address these factors. The authors developed a consensus statement that synthesizes evidence from research, evaluation, and the collective experience of an international research collaboration including experts in Indigenous medical education. The statement describes foundational processes that limit Indigenous health development in medical education and articulates key principles that can be applied at multiple levels to advance Indigenous health equity. The authors recognize colonization, racism, and privilege as fundamental determinants of Indigenous health that are also deeply embedded in Western medical education. In order to contribute effectively to Indigenous health development, medical education institutions must engage in decolonization processes and address racism and privilege at curricular and institutional levels. Indigenous health curricula must be formalized and comprehensive, and must be consistently reinforced in all educational environments. Institutions’ responsibilities extend to advocacy for health system and broader societal reform to reduce and eliminate health inequities. These activities must be adequately resourced and underpinned by investment in infrastructure and Indigenous leadership

"As natural as learning pathology" The design, implementation and impact of indigenous health curriucula within medical schools.

Initially drawing on the field of cultural safety and cultural competency, indigenous health has developed as a subject in its own right, defined from the perspective of indigenous populations. Current Australian and Aotearoa/New Zealand medical school accreditation processes require culturally responsive curricula and initiatives for indigenous peoples. To date, there has been little evidence to demonstrate whether medical schools are implementing and/or evaluating indigenous health curriculum. A Kaupapa Māori research theoretical framework was used to ensure an indigenous agenda was presented within the field of medical education. Two phases were employed: Phase one surveyed multiple medical sites in a case study (multiple sites bound by the concept of indigenous health curriculum), while phase two involved multiple stakeholders within one medical school site (multiple perspectives of indigenous health curriculum bound by one site). Semi-structured interviews were used to explore the same six subject areas of the medical school’s indigenous health curriculum across all stakeholder groups. Inductive analysis was used to encode and order the qualitative data. Data collected from quantitative surveys from each medical school site were collated and a comparative analysis presented. The findings revealed that the design of an indigenous health curriculum is highly influenced by the level of systems support, the recognition of the role of the indigenous community and the role of an indigenous health framework. The implementation of an indigenous health curriculum is characterised by a sequential method of delivery and the role given to stakeholders. The findings suggest that meaningful engagement with an indigenous community promotes transformative education and that such an approach has positive impacts on health care. As a result of the research three specific evaluation frameworks are proposed. Framework one provides the components necessary to map an indigenous health curriculum. Framework two documents a method to determine what constructive alignment looks like in an indigenous health curriculum, and framework three highlights the process by which engagement with indigenous stakeholders promotes a model of social accountability between the medical school and the indigenous community. This research argues for the use of evaluation frameworks that are able to draw on the complex interactions between variables that influence the design, implementation and evaluation of indigenous health curricula. The importance of an indigenous health framework as a core component of an indigenous health curriculum, which promotes transformative practice and community investment within a medical school and broader health environment is noted. This research also offers a counter narrative to those documented within the literature of negative health experiences by indigenous communities. This research found that an indigenous health medical curriculum can be a vehicle to promote positive health experiences as indigenous community members are re-positioned as key health stakeholders and experts in indigenous health, as opposed to solely ‘recipients’ of health care

"As natural as learning pathology" The design, implementation and impact of indigenous health curriucula within medical schools.

Initially drawing on the field of cultural safety and cultural competency, indigenous health has developed as a subject in its own right, defined from the perspective of indigenous populations. Current Australian and Aotearoa/New Zealand medical school accreditation processes require culturally responsive curricula and initiatives for indigenous peoples. To date, there has been little evidence to demonstrate whether medical schools are implementing and/or evaluating indigenous health curriculum. A Kaupapa Māori research theoretical framework was used to ensure an indigenous agenda was presented within the field of medical education. Two phases were employed: Phase one surveyed multiple medical sites in a case study (multiple sites bound by the concept of indigenous health curriculum), while phase two involved multiple stakeholders within one medical school site (multiple perspectives of indigenous health curriculum bound by one site). Semi-structured interviews were used to explore the same six subject areas of the medical school’s indigenous health curriculum across all stakeholder groups. Inductive analysis was used to encode and order the qualitative data. Data collected from quantitative surveys from each medical school site were collated and a comparative analysis presented. The findings revealed that the design of an indigenous health curriculum is highly influenced by the level of systems support, the recognition of the role of the indigenous community and the role of an indigenous health framework. The implementation of an indigenous health curriculum is characterised by a sequential method of delivery and the role given to stakeholders. The findings suggest that meaningful engagement with an indigenous community promotes transformative education and that such an approach has positive impacts on health care. As a result of the research three specific evaluation frameworks are proposed. Framework one provides the components necessary to map an indigenous health curriculum. Framework two documents a method to determine what constructive alignment looks like in an indigenous health curriculum, and framework three highlights the process by which engagement with indigenous stakeholders promotes a model of social accountability between the medical school and the indigenous community. This research argues for the use of evaluation frameworks that are able to draw on the complex interactions between variables that influence the design, implementation and evaluation of indigenous health curricula. The importance of an indigenous health framework as a core component of an indigenous health curriculum, which promotes transformative practice and community investment within a medical school and broader health environment is noted. This research also offers a counter narrative to those documented within the literature of negative health experiences by indigenous communities. This research found that an indigenous health medical curriculum can be a vehicle to promote positive health experiences as indigenous community members are re-positioned as key health stakeholders and experts in indigenous health, as opposed to solely ‘recipients’ of health care

Severe COPD and the transition to a palliative approach

Patients with severe chronic obstructive pulmonary disease (COPD) have a chaotic trajectory towards death. Research has focused on identifying a “transition point” that would allow identification of those patients who may benefit from a palliative approach to their care, or referral to a specialist palliative care service. This article aims to outline difficulties in identifying this transition point, summarise current literature on this topic and suggests a model based on clinical milestones. Educational aims To outline the difficulties associated with identifying patients with severe COPD who are at risk of dying. To summarise current research on this topic. Key points A specific transition point is difficult to identify in severe COPD. Tools are available that may assist the physician in identifying those at risk of dying. It is essential that the patient voice is heard, patients can describe specific events that may be used as a “trigger” for a palliative approach. Specialist palliative care services may only be required for a subgroup of patients whose needs cannot be managed by the primary care team

Indigenous health: designing a clinical orientation program valued by learners

Abstract Background Indigenous health programs are seen as a curriculum response to addressing health disparities and social accountability. Several interrelated teaching approaches to cultural competency curricula have been recommended, however evidence of the impact of these on learner outcomes including engagement and self-reported competencies is limited. We aimed to explore undergraduate medical student perspectives of an indigenous health orientation program to inform curriculum strategies that promote learning and development of clinical skills. Methods We analyzed quantitative and qualitative student evaluations (n = 602) of a three-day immersed indigenous health orientation program between 2006 and 2014 based on Likert-scale responses and open-text comments. We conducted a thematic analysis of narrative student experiences (n = 426). Results Overall, 509 of 551 respondents (92%) rated the indigenous health orientation program as extremely or highly valuable and most (87%) reported that the course strongly increased their interest in indigenous health. The features of the clinical course that enhanced value for learners included situated learning (learning environment; learning context); teaching qualities (enthusiasm and passion for Māori health; role-modelling); curriculum content (re-presenting Māori history; exploring Māori beliefs, values and practices; using a Māori health framework in clinical practice); teaching methodologies (multiple teaching methods; simulated patient interview); and building relationships with peers (getting to know the student cohort; developing professional working relationships). Conclusions Undergraduate medical students valued an indigenous health program delivered in an authentic indigenous environment and that explicitly reframed historical notions of indigenous health to contextualize learning. Content relevant to clinical practice, faculty knowledge, and strengthened peer interactions combined to build learner confidence and self-reported indigenous health competencies. These findings suggest empirical evidence to support a curriculum approach to indigenous health teaching that enhances clinical learning