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IPAC Presentation Sept 2013

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Linda Diffey

on 23 January 2014

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Transcript of IPAC Presentation Sept 2013

Listening to our relations: Integrating community needs assessment findings in undergraduate medical curriculum at the University of Manitoba
IPAC National Mentorship Forum
September 7, 2013

Planning the Indigenous Health
Longitudinal Course

Needs Assessment:
How can we improve our undergraduate medical curriculum to produce MDs that have the knowledge, skills and attitudes to work in a culturally safe way with FN/M/I patients, families and communities?

What should our model of community engagement for ongoing curriculum development, implementation and evaluation look like?
Barry Lavallee
Linda Diffey
Marcia Anderson DeCoteau

Presentation Outline:
New UGME Curriculum Structure
Pre-Clerkship (Med I-II)
Clerkship (Med III-IV)
Module 0: Foundation of Medicine
Module 1: Normal Biology & Health
Module 2: Health & Disease
Module 3: Consolidation
Module 4: Transition to Clerkship
Module 5: Core Rotations
Module 6: Pre-CaRMS Electives
Module 7: Transition to Residency
Clinical Reasoning
Professionalism
Clinical Skills
Community Health
Indigenous Health
Generalism
Geriatrics
Diagnostic Imaging
Health care systems
Interprofessional Education
Leadership
Palliative Care
Pediatrics
Informatics
Pathology
Core
Competencies
Pre-Clerkship
Clerkship
M0: Foundation of Medicine
M1: Normal Biology & Health
M2: Health & Disease
M3: Consolidation
M4: Transition to Clerkship
M5: Core Clinical Rotations
M6: Pre-CaRMS Electives
M7: Transition to Residency
Curriculum Development Process
1. Needs Assessment
2. Establish Learning Outcomes
3. Define the Content
4. Organize/Sequence the Content
5. Decide the Educational Strategies
6. Decide the Teaching Methods
7. Develop Assessment Methods
8. Communication of Curriculum
to Stakeholders
9. Educational Environment
10. Curriculum Management

Needs Assessment Process
Recommendations
for new curriculum
Community Focus Groups
& Interviews
Faculty Interviews
Analysis of Past Curriculum
Student/Grad Interview
Role of the Indigenous Health
Course Committee
Background/Context
New curricular structrure
Curriculum planning process
Needs assessment
Implementation plan
CHC4007
FPC30114
KD58
HD69
CS12
CS09
CS08
CHC3004
HD44
Lectures
Community visits
ITC Session
Family Medicine
Electives
CS12
KD58
HD44
Quick facts:
Manitoba is home to >150K Indigenous people (13.6%)
Approximately 1/3 live in Winnipeg
Winnipeg has the largest urban Indigenous population in Canada (8.6%)
Up to 40% of urban hospital patients are Indigenous
Indigenous people utilize hospitals and medical services at a rate 2-3X higher than other Manitobans
[Source: http://www.wrha.mb.ca/aboriginalhealth/about.php]
1997
2007
2008
2010
New Undergrad Medical
Curriculum Introduced (1997)
systems approach (vs. discipline/department based)

emphasis on self-directed learning, PBL, early clinical exposures

Indigenous health
concentrated in early portion of Med I in community health
discrete sessions, content not integrated, mostly didactic lectures
no formal role for Indigenous community
few Indigenous people on faculty/staff in med ed
Departmental Review of Indigenous Health Curriculum (2007)
Recommendations
content should reflect diversity among Manitoba's Indigenous population
decolonizing approach that is strength (vs. deficit) based
provide students with a context for understanding Indigenous health issues
Define a process for community consultation, participation and evaluation of the curriculum
IPAC-AFMC Core Competencies (2008)
University of Manitoba, along with the other Canadian medical schools, approves the adoption of the FNMI Core Competencies in undergrad medical curriculum
Organizational Developments (2010)
Section of FNMI Health formed comprising centres for education, research and service delivery

Associate Dean, FNMI Health position created

Curriculum renewal (CuRe) process initiated
targeted 2013 as launch for changes
task groups formed to explore opportunities for curricular change
Timeline
Purposive sampling of participants from key stakeholder groups

Staff at health programs, organizations and centres that provide services to Manitoba’s Indigenous populations

Members of Manitoba’s First Nations, Metis and Inuit communities who access health care services in the province

emerging themes...
communication
assumptions
/ stereotyping
access
/ barriers
balance of
power
understanding
culture
colonial
history
lived
experience
diversity
Implementing the new Indigenous health curriculum...
challenges
supporting communities and service agencies to participate in teaching med students
greater demands on Indigenous faculty
systemic racism
strengths
support within med school administration and department
formal positioning as a course
more autonomy re: curriculum decisions within Indigenous health
greater engagement/involvement with community
what will it look like?
meaningful engagement with Indigenous communities
voice on curriculum planning committee
both discrete and integrated components throughout all four years
incorporate critical self reflection as a skill
emphasis on communication and community-based learning
support for faculty/preceptors
novel teaching methods, minimal lectures, more experiential learning
employ a social justice/accountability lens
in conclusion....
"But when you come to the North, you don't have the diagnostic tools that you have in the South. So they have to have some thinking skills ...like when I came down I...worked in emerg and someone came in with a headache and they sent them for a CT. I was just like, what, are you kidding? Like use your assessment skills. Your skills have got to be very sharp....you don't rely on every little test and every blood result because you don't have...you have X-ray and you have a glucometer and you have a blood pressure monitor and you have an EKG, that's it."
"And that's the problem...and especially in rural areas and doctors that go and work on reservations...they go there, they know nothing about the culture and they come in with this high society attitude of they're better than the people that they're working with, when really I don't think anybody should be treated different if you're black, white, red, yellow - you're going to see a doctor. Everybody should be treated like a human being and treated with the same courtesy and the same respect, and just that separation already is what disturbs me about the whole medical system."
"They just presume...because you're Aboriginal, and especially males, they presume you're just coming in there for some certain pills. You know, pain killers or whatever the pill of the day is."
"....and there's doctors I think get fed up sometimes. They just feel like they're seeing the same things, the same...okay, there's a lot of alcoholism in the area. They're seeing a lot of people that come and I think they become numb. Like they become...they see everyone the same after a while. They don't see everyone as an individual."
resources - human and financial
positioning in the schedule (afternoons/non-core)
persistence!
Full transcript