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

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

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

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

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

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

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

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

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

Organising the Hauora Māori Curriculum

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’.

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

Te Iwi Māori - Population Ethnicity and ancestry Demography Māori health status The determinants of inequality Source: Robson B, Harris R. (eds) Hauora: Māori Standards of Health IV. A study of the years Wellington: Te Rōpū Rangahau Hauora a Eru Pōmare. Available at

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

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.

Implementation of Te Ara

Process for implementation Support programmes to map curricula against Te Ara –Identify areas that require development Identify the professional development and resource needs of each programme Develop curricula to ensure teaching, learning and assessment are aligned with Te Ara

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?

Challenges ahead

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 Hauora Māori teaching and learning closer to where the rubber hits the road

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?

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?

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