Ewen Shaun C, Hollinsworth David
Melbourne Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
Indigenous Studies, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sippy Downs, QLD, Australia.
Adv Med Educ Pract. 2016 May 27;7:311-5. doi: 10.2147/AMEP.S107334. eCollection 2016.
Attention to Aboriginal health has become mandatory in Australian medical education. In parallel, clinical management has increasingly used Aboriginality as an identifier in both decision making and reporting of morbidity and mortality. This focus is applauded in light of the gross inequalities in health outcomes between indigenous people and other Australians.
A purposive survey of relevant Australian and international literature was conducted to map the current state of play and identify concerns with efforts to teach cultural competence with Aboriginal people in medical schools and to provide "culturally appropriate" clinical care. The authors critically analyzed this literature in light of their experiences in teaching Aboriginal studies over six decades in many universities to generate examples of iatrogenic effects and possible responses.
Understanding how to most effectively embed Aboriginal content and perspectives in curriculum and how to best teach and assess these remains contested. This review canvasses these debates, arguing that well-intentioned efforts in medical education and clinical management can have iatrogenic impacts. Given the long history of racialization of Aboriginal people in Australian medicine and the relatively low levels of routine contact with Aboriginal people among students and clinicians, the review urges caution in compounding these iatrogenic effects and proposes strategies to combat or reduce them.
Long overdue efforts to recognize gaps and inadequacies in medical education about Aboriginal people and their health and to provide equitable health services and improved health outcomes are needed and welcome. Such efforts need to be critically examined and rigorously evaluated to avoid the reproduction of pathologizing stereotypes and reductionist explanations for persistent poor outcomes for Aboriginal people.
在澳大利亚医学教育中，关注原住民健康已成为一项强制性要求。与此同时，临床管理在发病率和死亡率的决策制定及报告中越来越多地将原住民身份作为一个标识。鉴于原住民与其他澳大利亚人在健康结果上存在巨大不平等，这种关注值得称赞。
对澳大利亚及国际相关文献进行了有目的的调查，以梳理当前的情况，并找出医学院校在教授与原住民的文化能力以及提供“文化上合适的”临床护理方面所做努力存在的问题。作者根据他们在多所大学六十多年来教授原住民研究的经验，对这些文献进行了批判性分析，以列举医源性影响的实例及可能的应对措施。
对于如何最有效地将原住民内容和观点融入课程，以及如何最好地教授和评估这些内容，仍存在争议。本综述探讨了这些争论，认为医学教育和临床管理中善意的努力可能会产生医源性影响。鉴于澳大利亚医学中对原住民的种族化历史悠久，且学生和临床医生与原住民的日常接触相对较少，本综述敦促在加剧这些医源性影响时要谨慎，并提出应对或减少这些影响的策略。
认识到医学教育中关于原住民及其健康的差距和不足，并提供公平的医疗服务和改善健康结果，这些早就该进行的努力是必要且值得欢迎的。此类努力需要经过批判性审视和严格评估，以避免对原住民持续不佳的健康结果进行病理化刻板印象的再现和简化解释。
