1. ‘Integrated Medical Training in Kimberley Aboriginal Community Controlled Health Services’

2. Jenny Poelina Co-ordinator Centre for Aboriginal Primary Health Care Training Education & Research (CAPTER) David Atkinson Medical Educator CAPTER Medical Coordinator RCSWA (UWA and UNDA)

3. Regional cooperative Formed in 1986 to provide: Accounting, stores and pharmacy Clinical governance Aboriginal health worker education Remote clinics services Population health and Information Technology Kimberley Aboriginal Medical Services Council

4. The Kimberley WA Ref: maps.google.com.au

5. Health Services in the Kimberley About twice the size of Victoria, 50,000 people, 40% Aboriginal 6 towns, 3 with procedural care - largely GP led services 1 resident physician, 2 Paediatricians, 2 Surgeons, 2 Psychiatrists, 1 O&G 16 permanently staffed remote clinics - 10 ACCHS & 6 WACHS Around 30 clinics with scheduled visiting staff by both road and air

6. Less than optimal infrastructure… Less than optimal infrastructure…

8. TIP # 5: Don’t forget to get out and about……

11. What has KAMSC achieved in health workforce education?

12. KAMSC Centre for Aboriginal PHC Training, Education and Research GP Registrars learning ultrasound Pharmacy assistant class of 2005 CAPTER staff 5 th year medical students 2005 AHW students – Class of 2005

13. Current Training & Education in Kimberley ACCHS Aboriginal Health Worker (Cert III, IV, Diploma, Advanced Diploma) Pharmacy Assistant – for ACCHS clinics Pharmacy students (UDRH program) Rural Clinical School (Medical Students) Final year GP placements, JFPP, electives etc General Practice –Resident Medical Officer (PGPPP) –Registrars Advanced Rural Skills Post GP registrars

14. Number of AHW graduates Cert III208 Cert IV194 Dip (since 2003) 76 Med II (since1986) 67 Adv dip in SEWB 8

16. Other students: Final year medical students - 50 per year Elective medical students - 15-20 per year Pharmacy - 8 per year for 4-8 weeks Pharmacy assistants - trained as reqd by clinics John Flynn - 4 to 6 through KAMSC per yr

17. How did we get here?

18. Aboriginal Health Worker Training in the Kimberley 1970s - 1983 On the Job & short courses Community selected AHWs were initially used in the community clinics & community health centres to interpret and be cultural brokers. They were taught basic obs, 1 st aid & how to treat common conditions. 1983 - 1985BRAMS (6 months) AHWs training was formalised and delivered on the veranda and under trees at the old convent were BRAMS established their first clinic. The AHWs graduated with a Certificate in Aboriginal Health Work

19. Graduates of 1983

20. 1986 – 2000 BRAMS/KAMSC State Training Accreditation Council Curricula 1986 Meeting in Broome of the 3 AHW training providers at the time in the state (BRAMS, PAMS, EKAMS) Statewide agreement on the course content and curriculum These basic skills & full certificate became the WA industry standard courses in Aboriginal Health Work. (training reviewed each year to ensure best practice) In addition the Kimberley developed the “Medication II course” to help AHWs practice safely in remote clinics 1994 “Certificate III in Aboriginal Health Work” (Remote Aboriginal Community) “Advanced Certificate in Aboriginal Health Work” was offered the WAACCHO training providers (KAMSC, Marr Mooditj, Bega Garnbirringu HS and Ngaanyatjarra HS.)

21. 1997 - customised and articulated courses 2000 - finally accredited by the WA Training Authority Council (TAC) as: “Certificate III in Aboriginal Health Primary Health Work” “Certificate IV in Aboriginal Primary Health Work” 2001- reaccredited as units of competence. KAMSC delivered “Certificate III in Aboriginal Health Work” “Certificate IV in Aboriginal Primary Health Care Practice” “Diploma in Aboriginal Primary Health Care Practice” “Training program in Aboriginal Primary Health Care Program work” Training program in Emergency Skills for Remote Areas” Training program in Counselling & Aboriginal SEWB”

22. 2002 – 2007 National Aboriginal &Torres Strait Islander Health Worker training review KAMSC Inc was a key stakeholder in the National review and was a member of the technical writing team & a validation site. 2008 National Accredited Training (HLT07 Health Training Packages) KAMSC Inc commenced delivery of the new qualifications in February 2008.

23. Pre 2002: Aboriginal Health Worker training Short term visiting medical students Occasional GP registrars (only when vacant positions or in private practice) Partnership with JCU - some population health training New nursing course Notre Dame University, Broome Campus Other health professional education in the Kimberley

24. 2002-2003 Educational partnerships Rural Clinical School, UWA WAGPET Combined Universities Department of Rural Health (the WA UDRH) Other health professional education in the Kimberley

26. Rural Clinical School funding - culmination of years of rural health lobbying, Max Kamien, Roger Strasser, Paul Worley etc. -Aboriginal health a stated priority, CAMDH and UWA sees this as an opportunity! NACCHO lobbying to get GP registrar salaries in ACCHSs paid by Dept of Health; and Change to GP registrar education from RACGP to GPET results in innovation funding Pharmacy Academics in University Departments of Rural Health (PAUDRH) initiative Policy changes leading to opportunities

27. How is the education integrated? Two way teaching - AHWs and medical students / RMOs / GP Registrars / Pharmacy students - formal and in clinic Registrars supervise and teach PGPPP doctors and students Registrars, PGPPP and students learn together at workshops, clinical meetings Students return as PGPPP doctors, PGPPP return as GP registrars, GP registrars stay on as GPs and as educators 3 of the 6 people paid with fractional RCS appointments this year were former Kimberley GP registrars)

28. Why is the education integrated? We want our workforce to work in teams and behave culturally appropriately Our AHWs need a variety of input and benefit from medical student and junior doctor teaching Teaching AHWs is very useful for the medical people when working with patients and with AHWs Everyone enjoys it more! Not enough resources to do it any other way!

29. Why the successes in the Kimberley? Aboriginal health is most of the work in the region - forcing at least some focus on Aboriginal health Remote and interesting to people from elsewhere – both the location and the diseases Committed people: Puggy Hunter, Henry Councillor, Ian Wronski, Maggie Grant, Richard Murray, DeeDee Cox and many more

30. How do we get this to happen elsewhere? KAMSC: Organisational commitment to training our own workforce Lobbying for policy change Taking advantage of opportunities that arise Luck? Elsewhere - Policy needs to be much more encouraging for ACCHS / coercive of universities Funding attached to meaningful targets!

31. Meaningful targets? Medical School funding tied to Aboriginal health (learn from rural health lobby) All students must do at least 4 weeks in an ACCHS during their medical training (4 of 80+ clinical weeks is only 5%) cut funding to Universities which do less. Assessment in Aboriginal health - local Aboriginal health organisations and AIDA sign off on assessment quality and quantity (and funded to do so) Additional funding for ACCHSs and Universities that do more!

34. KAMSC partners

35. TIP # 5: Don’t forget to get out and about……