Implementing the new Australian Medical Council standards: The focus on Indigenous health Professor Michael Field Chair, Medical School Accreditation Committee, AMC

AMC accreditation in brief Assesses and accredits basic & postgraduate medical education and training programs in Australia & New Zealand. –Assess against explicit standards developed in collaboration with stakeholders –Assess by peer review –Results in a public report –Mandatory for medical schools, voluntary for colleges

Power of Accreditation Promotes regular self assessment Addresses stakeholder interests, e.g. choice of team members Team visit fosters exchange of ideas Reports highlight strengths AND challenges Covers issues other than students’ knowledge, e.g. student selection & support, relations between school and health services

Accreditation Processes 1 AMC promulgates clear accreditation standards: does not prescribe curricula, but supports diversity College/medical school completes self assessment AMC chooses Team (medical & non- medical) College/medical school produces submission organised around AMC accreditation standards Team meets, reviews documents, formulates questions, plans assessment AMC gathers additional information for Team

An AMC Team

Accreditation Processes 2 Team site visits and meetings (1 -2 weeks) Team presents preliminary findings AMC invites feedback on the process Team writes report against accreditation standards Report reviewed by school/college, & AMC accreditation committee Council grants accreditation – range of options

Indigenous health and the AMC standards 2000: Active engagement with a wide range of stakeholders, consumers, trainees, health professions Inconsistency - focus on Maori health during NZ visits but limited focus on Indigenous health in Australian visits Indigenous Health Curriculum Framework supported by the medical schools & adopted by AMC in 2004 Only such framework adopted by AMC : AMC working parties review accreditation standards New standards approved by Council in July 2006 after stakeholder consultation

Standards & Guidelines The standards –articulate the specific requirements that Schools are required to meet The guidelines –reflect AMC’s understanding of best practice –provide more detail about the areas that need to be covered in addressing the standard

Principles Australia has special responsibilities to Aboriginal and Torres Strait Islander people, and New Zealand to Maori, and these responsibilities should be reflected throughout the medical education process. Doctors work in a context in which the Indigenous peoples of Australia and New Zealand bear the burden of gross social, cultural and health inequity.

Explicit Indigenous content 1 Educational expertise –appropriate use of educational expertise, including the educational expertise of Indigenous people, in the development & management of the medical course Interaction with the health sector –School recognises the unique challenges faced by Indigenous health services, and has effective partnerships with relevant local communities, organisations & individuals

Explicit Indigenous content 2 Staff appointment, promotion and development –employment practices are culturally inclusive Mission –mission addresses Indigenous peoples & their health Curriculum structure, composition & duration –the course provides a comprehensive coverage of Indigenous health (history, cultural development and health of Indigenous people) Ongoing monitoring –implementation of Indigenous Health Curriculum Framework reviewed on a regular basis

Explicit Indigenous content 3 Student intake –clearly defined quotas for students from under-represented groups, including Indigenous students (specific admission and recruitment processes) Student support –appropriate student support to cater for the needs of students including social, cultural and personal needs

Explicit Indigenous content 4 Clinical teaching resources –provides all students with experience of the provision of health care to Indigenous people in a range of settings and locations

Implementation 1 From January 2007, medical schools must describe their programs/processes and demonstrate their success. Will be assessed by AMC teams AMC/AIDA/MDANZ plan to evaluate new standards’ effectiveness. New questions for the assessment of overseas trained doctors. Promulgate AMC changes internationally In the future - Colleges?

Implementation 2 Changes at the AMC –team chairs & members briefed on changes –culturally appropriate process and guidelines –train teams to question school’s statements and to measure success –expand the pool of trained Australian Aboriginal & Torres Strait Islander team members and Maori team members

Assessment tools AMC encourages self-reflection and critical analysis of performance & plans Identification of strengths, challenges & processes for addressing challenges Critical Reflection Tool –Schools can use as part of their self- assessment –Consistent with AMC standards AMC Assessment –Standards used to ask specific questions and gather data Interviews with stakeholders – staff, students, clinicians, community leaders

S1S2S3S4S5S6 <0707<0707<0707<0707<0707<0707 Reference group na  na  Mission na   na Curriculum development na na Curriculum content na  na Employment strategy ?? na ? na  Placements  na  na Admissions  na ? na  Support unit  na ? na 

Strengths Schools with an explicit Indigenous focus are, on the whole, building on existing achievements New schools report that they are addressing Indigenous health in curriculum development Most schools report including explicit Indigenous content in their curriculum

Issues and areas needing consideration Robustness of Indigenous input –depth of reported input variable –needs to be formalised Clinical experience with Indigenous people –highly variable in quality, duration & accessibility of opportunities Indigenous student recruitment –challenge of meeting quota

Outcomes of Assessment AMC provides feedback via accreditation report Ongoing follow-up of outstanding issues: –Periodic reports –Explicit reporting requirements with set timeframes –Follow-up visits –Limited accreditation

Conclusion Incorporation of specific Indigenous standards has raised the awareness of the importance of addressing these issues for schools Schools appear committed to addressing Indigenous health needs in the curriculum Need time for longitudinal impacts to emerge

Acknowledgements Johann Sheehan, AMC Theanne Walters, AMC AMC Team chairs and members Medical School deans