1. Faculty/Presenter Disclosure
•
Faculty: DR DEBORAH JANE FEARON
•
Relationships with commercial interests:
SENIOR LECTURER IN RURAL AND REMOTE MEDICINE, FLINDERS UNIVERSITY
CLINICAL DEAN AND CONSULTANT PAEDIATRICIAN, ALICE SPRINGS HOSPITAL
2. Disclosure of Commercial Support
•
This program has received in-kind support from Centre for Remote Health in the form of employment of a Project Manager.
•
Potential for conflict(s) of interest:
Deborah Jane Fearon has not received payment from any pharmaceutical company nor organisation associated with a pharmaceutical company.
4. Acknowledgements
•
We pay our respects to the First Peoples of this country and the lands on which we work.
Tjukurpa of Uluru,
by Malya Teamay
5. Learning to ‘Fly’ in Central Australia
Experiences with Piloting a Third Year Longitudinal Integrated Clerkship
in Alice Springs Hospital.
Dr Debbie Fearon, Senior Lecturer, Flinders University
Dr Carole Reeve, Senior Lecturer, Flinders University
Dr Sheela Joseph, Lecturer, Flinders University
Ms Kellie Schouten, Project Officer for Evaluation of LIFT
A/Prof Kerry Taylor, Deputy Director, Poche Centre for Indigenous Health & Wellbeing
6. Context
•
Alice Springs -remote town, approx.28,000 pop.
•
Alice Springs Hospital -smallest, most remote teaching hospital in Australia (1500kms to next)
–
189 beds
–
Service area = 1.6 million square kilometres
–
Covers approximately 50,000 people across 4 states/territories of Australia
–
Approx 50% population are Australian Aboriginal (Indigenous), but they are up to 80% of the health service users
–
Emergency department has about 40,000 presentations p/a
8. Medical education in Alice Springs
•
In 2005, introduced six-month Community-Based Medical Education (CBME) program
–
continued the pioneering placement of Year 3 students in rural communities started by Flinders in the PRCC program in 1997.
•
Program initially based in the community but:
–
lack of local General Practice resources led to the students being placed in the hospital in block placements, while keeping their longitudinal experience with GP’s from Central Australian Aboriginal Congress and Central Clinic.
–
basically a hybrid LIC program.
–
during the remaining 6 months, students were based in Royal Darwin Hospital doing four-week ward block placements.
10. Medical education in Alice Springs
•
In 2013, Flinders University introduced a year-long, fully integrated, longitudinal program that incorporated Alice Springs Hospital, Central Australian Aboriginal Congress and Central Clinic.
•
The name given to the program was AKALTYE-IRREME ATENGENTYELE, which means “Learning through Cooperation” in Arrernte. However, it has become colloquially known as LIFT (Longitudinal Integrated Flinders Term).
•
The first year of the LIFT program was largely based on the LIC programs in Cambridge (Harvard) and San Francisco, which are urban teaching hospitals.
•
The initial timetable linked students with specific preceptors in each specialty and placed students in hospital outpatient clinics
•
In addition, students did up to two half-day sessions at CAAC and/or Central Clinic with a specific GP
11.
12. Aims of the AKALTYE-IRREME ATENGENTYELE (LIFT) program
•
Deliver a comprehensive clinical curriculum that fulfils the key components of a LIC program: continuity, patient-led learning and integration of knowledge.
•
Produce academically-excellent students who will attain all of the required AMC graduate outcomes and who will be ready for Internship in any hospital in Australasia on graduation
•
Ensure students are culturally safe practitioners that are cognisant of the special circumstances of local Indigenous clients.
•
Ensure students are willing and able to work within multi-disciplinary teams.
•
Encourage and inspire students to work as doctors in rural and remote health, especially in the under-served areas of the Northern Territory
13. Enablers to implementing the AKALTYE-IRREME ATENGENTYELE (LIFT) program in Alice Springs
•
Strong support, encouragement and valuable advice from Flinders University School of Medicine
•
Increasing evidence-base in the literature supporting LIC programs
•
Strong commitment to educating medical students from local clinicians, academics and cultural educators
•
Support from hospital and clinic management and Northern Territory Department of Health
•
Broad case-mix of patients and breadth of specialties provided in Alice Springs
16. Student and clinician feedback: positive aspects of the AKALTYE-IRREME ATENGENTYELE (LIFT) program in ASH
•
Adult learning principles emphasised
•
Being treated as “near-peers”
•
Genuine flexibility in time-tabling
•
Patient-led learning
•
Vertical and horizontal integration of learning
•
Role-modelling and relationships with some senior clinicians
•
I-pads and Wifi access
17. Student and clinician feedback: Negative aspects of the AKALTYE-IRREME ATENGENTYELE (LIFT) program in ASH
•
Lack of communication between hospital and community
•
Lack of clinical space in outpatient clinics and emergency department
•
Poor IT resources in hospital setting
•
High senior staff workload and issues with staff retention
•
Issues with hidden curriculum, and inability of healthcare system to provide culturally appropriate care
•
Student group dynamics and relative isolation of students from peers
•
Perceived lack of core clinical skills and basic science knowledge in students from NTMP
•
Community engagement between Flinders University and Alice Springs
•
Political issues
18. Academic outcomes for students
•
Student academic marks and class ranking analysed
–
random week of student activity audited and compared to local CBME students.
•
All four LIFT students passed Year 3 well, with two credits and two distinctions.
•
Three of these students substantially increased their class ranking.
•
Audit showed a good integration of clinical exposure mid-way through the year
•
NTMP had five students reach distinction in 2013
–
four of those were either ASH LIFT or Alice Springs CBME
19. Flinders actions
•
Increased orientation to hospital
•
Appointed Clinical Dean in Alice Springs Hospital
•
Academic support increased
•
Funding to specific departments to allow clinician time to be set aside for teaching
•
Poche Centre and Indigenous academics enlisted for increased help with cultural safety training, and assistance with student communication issues with Indigenous clients
•
Clinician involvement sought for University Committees, implementation of the NTMP and curriculum changes
•
Progressive clinical skills curriculum designed by academics and clinicians from Darwin
•
Simulation equipment supplied
20. Flinders actions
•
Decreased number of Year 4 students to make room for Year 3 (went from 101 Year 4 placements in 2013, to 69 in 2014)
•
Increased use of departmental teaching, intern teaching and interdisciplinary courses
•
Funding for more outpatient clinic rooms for parallel consulting (when outpatients are refurbished)
•
Senior academic support for ongoing evaluation
•
Community engagement
21.
22. Evaluation of AKALTYE-IRREME ATENGENTYELE (LIFT) in 2014
•
Students will be asked to complete a detailed questionnaire about their view of the program
•
Comparison of student clinical reasoning ability at the start and the end of Year 3 (in conjunction with LIFT in Adelaide)
•
Students will be asked in a focus group their understanding and knowledge of concepts such as the hidden curriculum and role- modeling
•
Analysis of student academic marks and class ranking
•
Clinicians will be asked their opinion by electronic questionnaire
•
Panel patient’s that were consented by the students will be interviewed
•
(Student empathy rating)
23. Where to from here?
•
Evaluation and other feedback to inform future program structure and delivery
•
Consider: context of high patient turnover, high staff turnover, underlying student characteristics, lack of clinic space and patient profiles has prevented implementation of traditional “LIC”
•
Might have to consider moving back to a more hybrid program
•
Utilise more academic teaching resources from outside the hospital for assistance with teaching basic clinical skills and using SIM equipment
•
Encourage more interdisciplinary teaching and community engagement
•
Basic LIC principles to be repeatedly communicated with clinicians and students to ensure common expectations
