The review of Aboriginal and Torres Strait Islander content within an
undergraduate paramedicine degree curriculum
Lisa Holmes1, Leanne Vance1, Ella Rust1
Abstract
A review of Aboriginal and Torres Strait Islander content in an
accredited paramedicine degree curriculum was undertaken as part of a
major course review and ongoing program evaluation. The aim was to
ensure the course content was appropriate and relevant to Aboriginal
and Torres Strait Islander communities. All content and teaching
activities were audited, where specific content was explored and noted.
Findings were presented to a review team where good practice was
highlighted, and areas for development were addressed. This has
encouraged staff to seek opportunities to embed content in both
clinical and non-clinical skills, knowledge teaching and experiences,
in addition to encouraging further review of other diverse communities.
Keywords: Aboriginal and Torres Strait Islander educational content, health
education, prehospital, paramedicine
1 Australia, 6027.Allied Health, School of Medical and Health
Science, Edith Cowan University, Joondalup, Perth, Western Australia, 6027.
Corresponding author:Dr Lisa Holmes -
[email protected]
Introduction
This paper presents how Aboriginal and Torres Strait Islander content and
approaches have been reviewed and embedded across an undergraduate
paramedicine degree program in Western Australia. This is to ensure that
this community is reflected in the skills and knowledge teaching and
assessment across the prehospital curriculum and enhance the practice of
paramedic students. In addition to meeting the Australian Health
Practitioner Regulatory Agency (AHPRA), registration of professional
capabilities for paramedics was established by the Paramedicine Board of
Australia (Paramedicine Board 2021).
A previous audit of the curriculum's Aboriginal and Torres Strait Islander
content was conducted in 2020. It showed that while relevant content was
evident, it was often discussion-based, not formalised or assessed and
frequently taught in standalone modules. The audit was the start of a
continuous development process concerned with maximising opportunities for
graduate work and empathetic future paramedics who deliver culturally safe
patient care in our communities.
The review discussed in this paper followed the 2020 audit of the
undergraduate paramedicine curriculum. It evaluates the progress, identifies
good practice and highlights areas needing further development. As this
project was an evaluation of a program already occurring for students,
ethics approval was deemed unnecessary. Reviewers consisted of stakeholders
representing the university, paramedic profession and communities. All of
whom expressed an interest in participating. The process took two months,
during which the curriculum content and resources were reviewed, Aboriginal
and Torres Strait Islander-related items were noted, and further context
was gained from the unit coordinators. This information was then collated
and presented to the stakeholders. Discussions regarding the content were
conducted, the use of good practice and areas for further development were
identified and feedback provided. This will be re-evaluated in 12-18
months. The desired outcome of this review was and continues to be the
normalisation of Aboriginal and Torres Strait Islander content throughout
the course. This simulates paramedic practice, as the cultural background
of patients is not always known from the initial emergency call. Therefore,
students and future paramedics need to respond in the moment, and preparing
for diversity enables students to learn from situations, practice skills
and gain confidence in safe educational spaces. While it is not possible to
cover all cultures, preferences and situations, promoting an empathetic and
respectful approach to patient-centred care is key.
The results from the review showed that many units were identified as
containing a considerable amount of content regarding Aboriginal and Torres
Strait Islander people in Australia. A conscious effort to embrace
Aboriginal educational practices was evident, with the utilisation of
yarning and storytelling activities to share experiences and offer
teachings that prepare and encourage students as they develop their
paramedical practice. From an educational perspective, Elders are central
to First Nation pedagogy. They teach and maintain culture, traditions,
ideals, knowledge and life lessons across the community through informal
teachings, storytelling and role modelling. This type of teaching is
considered informal in the Western paradigm because it has no predetermined
standardised curriculum or structure (First Nations Pedagogy 2023).
However, utilising this style of sharing experiences and practices in the
curriculum, delivered by those with lived experiences, has proved highly
credible with students. An example of this is the use of a wide variety of
guest speakers in the Clinical Placement Units, where students are prepared
for placements and, ultimately, employment with ambulance services or
communities. Guest speakers include paramedics, other first responders,
nurses, lawyers, community service providers and alumni attending class to
share their experiences informally and openly. This offers students insight
into a diverse range of patient care scenarios with a focus on lawful,
patient-centred, culturally safe, respectful and dignified care for all.
The shared experiences also supplement the information taught across the
course and clearly demonstrate its application.
Some examples are:
|
Unit
|
Topics
|
Examples of Activities and Resources
|
|
Perspectives in paramedic professional practice (First year,
first semester unit)
|
Exploring own culture
Sharing experiences
Aboriginal and Torres Strait Islander narratives on culture
|
Introduction to regular yarning and safe spaces. These are
scaffolded and supported with regular activities where a
wide variety of reflective topics are discussed.
Initially, an explanation on the purpose of yarning and
the benefits of creating a safe, non-judgemental educational
space is shared. Increasingly challenging and educational
topics in the context of the course are discussed, for
example, their own journey, culture, family, human
nature, judgement, bias, racism and death. Each
participating student has the opportunity to be heard by
all and respond accordingly in this safe and nurturing
environment.
Students reflect on the meaning of culture and related
terms, then share their own cultural experiences.
Utilisation of cultural empathy and challenging attitudes
through indigenous narratives resources (Edith Cowan
University 2012). This is part of a project led by Edith
Cowan University in conjunction with non-health-service
sectors, educators and health professionals to collaborate
as a reflective, multi-disciplinary team with shared visions
and goals (Edith Cowan University 2012).
Use of 'Interprofessional ambulatory care program - Creating
cultural empathy, ensuring Client centred care' (ECU Health
Simulation Centre 2012). This interprofessional learning
through simulation resource package has been designed to
support the facilitation of interprofessional learning
among students and practitioners interested in developing
their skills and knowledge of interprofessional practice.
|
|
Lifespan development for paramedics
|
Related epidemiology
Cultural awareness in the community
|
An end-of-life culturally sensitive learning activity with a
focus on related history-taking documentation. This activity
builds across the unit, applying learnings along the way.
|
|
Emergency mental health response
|
Aboriginal and Torres Strait Islander narratives on mental
health and belief systems
Drugs and alcohol
Homelessness
Overrepresented communities
|
The utilisation of 'Embrace', a multicultural mental health
resource with narratives, activities, and discussion
(Embrace Multicultural Mental Health 2020).
Use of 'The Framework for Mental Health in Multicultural
Australia', which is a nationally available online resource,
allowing practitioners to evaluate and enhance their
cultural responsiveness, through detailed narratives from
consumers with lived experience (Mental Health Commission
2014).
Collaboration with the Western Australian Network of Alcohol
and Other Drug Agencies and Peer Based Harm Reduction,
for community education and support across metro, rural
and remote services.
|
|
Clinical skills for paramedical practice 1
|
Practical clinical scenarios
|
The integration of Aboriginal and Torres Strait Islander
representation of patients with common medical conditions,
such as cardiovascular disease and chronic kidney
disease. These are not limited to Indigenous Australians;
however, discussion in debrief is based around the
increased prevalence of these diseases in the population.
|
|
Cultural studies
Written and delivered by Kurongkurl Katitjin Centre for
Indigenous Australian Education and Research
|
Introduction to culture
Culture in healthcare systems
Strategies to promote equity in health practices
Communicating with people from culturally diverse
backgrounds
Building cultural reflexivity
|
This unit explores cross-cultural understanding through
development of lifelong learning principles informed by
professional and ethical considerations in health
systems. Aboriginal and Torres Strait Islander health is
the primary focus of the unit; however, cultural safety
and capability will be applied to additional contexts.
|
|
Trauma studies for paramedics
|
Prevalence in populations
Aboriginal and Torres Strait Islander scenarios
|
Embedded in case studies throughout, lecturers share their
own experiences in the prehospital environment using
storytelling, giving context and application of learning
and opportunities to address queries from students.
|
|
Paramedic clinical placements 1st, 2
nd
and 3 rd years
|
Experience and reflection on placement experiences in
various communities
Continuing professional development planning and goal
setting
Links to AHPRA paramedic professional domains and
capabilities
Volunteering in a medical setting
Aged care
Transitional care
GP clinics
Mental health
Community care
Drugs and alcohol
Emergency department
Intensive care unit
Theatre wards
Ambulance observer shifts
Rural and remote locations
|
Portfolio is built around the domains for the AHPRA
professional capabilities for registered paramedics. The
domains cover all communities across Australia, including
Aboriginal and Torres and Strait Islander communities.
Sessions are presented by experienced paramedics or nurses,
who also share their own experiences through
storytelling.
Self-reflection by the paramedic students is undertaken to
enable growth in cultural awareness and a self-assessment of
the conversation, patient rapport and overall patient
treatment. While this process is not limited to the
Indigenous population, it provides an avenue to reflect
on the level of cultural awareness of the individual and
make effective improvements as required.
International placements are undertaken with diverse
populations and healthcare systems, including community
and rural hospitals in Bali, Indonesia, and ambulance
services in the United Kingdom and United States of
America.
|
|
Medical studies for paramedics 1
|
Associated diseases and epidemiology diseases in Aboriginal
and Torres Strait Islander people
|
Unit consists of lecture-based content with case studies.
|
|
Clinical skills for paramedical practice 2
|
Common medical conditions (e.g., mental and substance abuse
disorders and neurological disorders).
|
Practical scenarios cover a variety of patients. Debriefs
are based around the increased prevalence of specific
diseases and issues in the Aboriginal and Torres Strait
Islander populations.
Paramedics share their experiences through storytelling
techniques in the prehospital context.
|
|
Medical studies for paramedics 2
|
Associated diseases and epidemiology (advanced)
Co-occurring disorders and illnesses
Treatments available in metro, rural and remote areas
|
Unit consists of lecture content and case studies.
|
|
Introduction to pharmacology
|
Medications for prevalent diseases and epidemiology
|
Unit consists of lecture content.
|
|
Prehospital diagnostic techniques
|
Inclusion of population and diagnostic techniques
|
Unit consists of lecture content and case studies.
|
As previously outlined, the initial findings of the review were encouraging,
with clear evidence of Aboriginal and Torres Strait Islander content already
embedded in units. The review also identified areas of content that could be
further enhanced. For example, the inclusion of resources created by or in
collaboration with Aboriginal and Torres Strait Islander authors. As
paramedicine is a relatively young profession, with registration in
Australia occurring in 2018, literature and resources on prehospital
practice from Aboriginal authors are very limited. It is hoped that as the
profession continues to grow in Australia more will be written and
subsequently included in the course.
This review has increased the inclusion of authentic content and
experiences that enable students to consider ethical and cultural paramedic
practices, their own views and prejudices. This encourages open and honest
exchange and exploration with peers and other professionals. While this can
be uncomfortable, with the professional and sensitive approach from
lecturers, it is hoped this will promote a more empathic approach to
patient care and interprofessional working with Aboriginal and Torres
Strait Islander patients, families, bystanders and colleagues.
This review has resulted in an ongoing collaboration with graduated
Aboriginal and Torres Strait Islander students, who are now working in
ambulance services. They have and will continue to assist in the continuous
development and creation of relevant cultural scenarios, aimed at enhancing
students' cultural awareness and sensitivity. It is hoped that other
interested parties and stakeholders will come together to join a specialist
group-which will expand to cover other cultures to ensure the continued
embedding of relevant content, scenarios and related activities. This will
lead to ongoing evaluation of the developments through feedback from
students, staff and stakeholders.
During this review, continuous engagement with the Kurongkurl Katitjin
Centre for Indigenous Australian Education and Research was vital to ensure
that appropriate approaches and resources were promoted and used. The
paramedicine teaching team have been encouraged to undertake an internal
micro credential, called 'Infusing Aboriginal Content and Perspectives'.
This, along with ongoing advice from the Kurongkurl Katitjin Centre, aids
the development of culturally relevant and safe units, course content,
resources and assessments, benefiting the outcomes for students, patients
and colleagues.
The structure of this review has provided further opportunities to explore
other areas of diversity encountered in the prehospital emergency
environment, such as LGBTIQ+ communities and individuals with specific
needs. Thus, this encourages the growth of paramedicine students' skills
and confidence to be respectful, professional and empathetic in all
clinical and non-clinical interactions. This makes for a more relevant and
community-focused degree, maximising opportunities for students to gain
employment. This is particularly important as community paramedicine is a
growing area in which paramedics work in clinical roles outside of
ambulance services.
Conflict of interest
The authors declare no conflicts of interest.
Funding
This project did not receive funding.
References
ECU Health Simulation Centre 2012,
Interprofessional ambulatory care program - Creating cultural empathy,
ensuring client centred care
, viewed 1 December 2022.
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Creating cultural empathy and challenging attitudes through Indigenous
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