Abbott Penelope, Reath Jennifer, Gordon Elaine, Dave Darshana, Harnden Chris, Hu Wendy, Kozianski Emma, Carriage Cris
School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751, Australia.
BMC Med Educ. 2014 Aug 13;14:167. doi: 10.1186/1472-6920-14-167.
General Practitioner (GP) Supervisors have a key yet poorly defined role in promoting the cultural competence of GP Registrars who provide healthcare to Aboriginal and Torres Strait Islander people during their training placements. Given the markedly poorer health of Indigenous Australians, it is important that GP training and supervision of Registrars includes assessment and teaching which address the well documented barriers to accessing health care.
A simulated consultation between a GP Registrar and an Aboriginal patient, which illustrated inadequacies in communication and cultural awareness, was viewed by GP Supervisors and Medical Educators during two workshops in 2012. Participants documented teaching points arising from the consultation which they would prioritise in supervision provided to the Registrar. Content analysis was performed to determine the type and detail of the planned feedback. Field notes from workshop discussions and participant evaluations were used to gain insight into participant confidence in cross cultural supervision.
Sixty four of 75 GPs who attended the workshops participated in the research. Although all documented plans for detailed teaching on the Registrar's generic communication and consultation skills, only 72% referred to culture or to the patient's Aboriginality. Few GPs (8%) documented a plan to advise on national health initiatives supporting access for Aboriginal and Torres Strait Islander people. A lack of Supervisor confidence in providing guidance on cross cultural consulting with Aboriginal patients was identified.
The role of GP Supervisors in promoting the cultural competence of GP Registrars consulting with Aboriginal and Torres Strait Islander patients could be strengthened. A sole focus on generic communication and consultation skills may lead to inadequate consideration of the health disparities faced by Indigenous peoples and of the need to ensure Registrars utilise health supports designed to decrease the disadvantage faced by vulnerable populations.
在全科医生注册实习生培训期间，全科医生（GP）督导员在提升其为原住民和托雷斯海峡岛民提供医疗服务时的文化能力方面，扮演着关键但定义模糊的角色。鉴于澳大利亚原住民健康状况明显较差，全科医生培训及对注册实习生的督导应包括评估和教学，以解决诸多已被充分记录的获取医疗服务的障碍。
2012年的两次研讨会上，全科医生督导员和医学教育工作者观看了一段全科医生注册实习生与原住民患者的模拟会诊视频，视频展示了沟通和文化意识方面的不足。参与者记录了会诊中产生的教学要点，并确定在对注册实习生的督导中应优先考虑哪些要点。进行内容分析以确定计划反馈的类型和细节。利用研讨会讨论的现场记录和参与者评估，深入了解参与者在跨文化督导方面的信心。
参加研讨会的75名全科医生中有64名参与了研究。尽管所有人都记录了针对注册实习生一般沟通和会诊技能进行详细教学的计划，但只有72%提到了文化或患者的原住民身份。很少有全科医生（8%）记录了就支持原住民和托雷斯海峡岛民获取医疗服务的国家卫生倡议提供建议的计划。研究发现督导员在为与原住民患者进行跨文化会诊提供指导方面缺乏信心。
全科医生督导员在提升全科医生注册实习生与原住民和托雷斯海峡岛民患者会诊时的文化能力方面的作用可以得到加强。仅关注一般沟通和会诊技能可能导致对原住民面临的健康差距以及确保注册实习生利用旨在减少弱势群体劣势的医疗支持的必要性考虑不足。
