Graduating doctors for the community

Graduating doctors for the community

Western Sydney University’s School of Medicine is a leader in graduating students – both Indigenous and non-Indigenous – with the skills and cultural proficiency to improve health outcomes for Aboriginal and Torres Strait Islander patients.

Western Sydney University (WSU) opened the doors of its medical program in 2007, preferencing applicants from Western Sydney to address a scarcity of doctors in the region. A second major driver was to grow the number of Indigenous doctors, given Western Sydney has the highest Aboriginal and Torres Strait Islander population in Australia.

“The whole course is underpinned by this model of social accountability, so the doctors trained here have a kind of ingrained understanding that they’re accountable to their community and society, and that being Western Sydney, it’s a relatively socially disadvantaged society,” says Paul Saunders, a doctor and Senior Academic with WSU School of Medicine. “We want to select students embedded in the community who will go back and be a doctor for that community.”

As a young Biripi man living and working on Dharawal land in Western Sydney, Paul was part of the very first cohort of WSU medical students in 2007. Now on staff, he has witnessed the level of support for Indigenous students rise from relatively little when he was studying, to the current wrap-around program which is empowering a growing number of Aboriginal medical students to graduate from Medicine.

Embedding Indigenous Health

The medical curriculum Paul teaches has Indigenous Health embedded across each year of the five-year degree.

“We develop the students’ knowledge of Indigenous cultures, then try to influence attitudinal change, which is the foundation for skills development – like how to communicate with an Indigenous person, understanding the resources available for you in the clinical setting, and being able to apply these skills in practice. That process takes five years. It’s not something you can do in the first year; it’s a transformational approach running across the whole course,” he says.
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“You’re never going to be culturally proficient until you’re actually embedded within that community, seeing Aboriginal patients coming in the door and communicating and treating them.”
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“Cultural immersion is a big factor. You’re never going to be culturally proficient until you’re actually embedded within that community, seeing Aboriginal patients coming in the door and communicating and treating them.”

WSU is in an enviably strong position to offer its medical students cultural immersion, due to the strong relationships it has built with Aboriginal Medical Services (AMSs) around NSW.

“It’s not as easy as just going out and saying, ‘Will you take on our students? There will be a fee in it for you’. It’s about building a relationship based on trust. A lot of Aboriginal communities have been approached about an arrangement or a deal and then been left in the lurch. That’s happened all too often. So now it’s about trust; about showing your face regularly and being cautious about promising too much,” Paul says.

The Dean of Medicine at WSU, Distinguished Professor Annemarie Hennessy, has worked hard over a decade to develop and maintain the school’s good relationships with AMSs. Working with her in the leadership team is Professor Aunty Kerrie Doyle, Associate Dean, Indigenous Health. Another key team member is Uncle Ian Kennedy, who has the complex job of managing the students on clinical placements in AMSs around the state and plays a major part in maintaining the good relationships which give WSU access to these organisations.
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“It took three years to build the partnership with Broken Hill, and schools looking to forge similar partnerships with Aboriginal-controlled organisations should count on a similar lead time”
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WSU most recently partnered with the AMS in Broken Hill, which includes Wilcannia and three small AMSs near the border of NSW and South Australia, where WSU students fly in and out for clinical placements. It took three years to build the partnership with Broken Hill and schools looking to forge similar partnerships with Aboriginal-controlled organisations should count on a similar lead time, Aunty Kerrie says. To help convey lessons learned, she is writing a handbook documenting the team’s collective experience in building positive relationships with Aboriginal communities and organisations.

Graduating more Indigenous Doctors

The recruitment target at WSU is ten Indigenous students per year, within a total cohort of 130 to 140 commencing students. It was once difficult to recruit the ten, but Indigenous applications have grown to 20 to 30 per year and the target is now generally achievable.

“We start giving parents information about the medical course when their kids are in Year 6, and we run a FutureDoctors@email for people to let the school know they are thinking of doing medicine so we can keep our eye on them and get in touch once a year. We send some of our students into high schools to say, ‘Think about becoming a doctor; this is what you have to do’. It’s a big team effort,” Aunty Kerrie says.

When Annemarie recruited Aunty Kerrie to the position of Associate Dean, the medical program had a fairly high rate of attrition of Indigenous students in the early years of the degree. The wrap-around Indigenous student support program now overseen by Aunty Kerrie aims to minimise the life pressures many Indigenous students are dealing with, to allow them to focus more on their medical studies.

On the second day of each year’s Orientation Week, all Year One students in Medicine are taken to the Tharawal Aboriginal Corporation for a cultural immersion day where they meet some of the local Elders, learn some Indigenous knowledge and history of the surrounding Campbelltown area, and watch an Aboriginal performance.

“Right at the start, what that does for the Indigenous students is they get this feeling that their culture is accepted and valued within medicine. It’s like giving them permission to continue to be proud of their culture while they’re in the course and makes them feel more at ease,” she says.

The holistic support provided to Indigenous students by the school includes:

• Onboarding well before the students arrive.
• A tutor assigned to each student
• An Indigenous support centre close to the medical school, providing access to a kitchen, food, computers, textbooks and anything else students need to study effectively
• A weekly food hamper, recognising the financial constraints of many students
• In addition to the Puggy Hunter scholarship (available to all Indigenous students in a health discipline), a $7,500 housing scholarship available for those struggling to pay for accommodation or coming to university from a distant location
• Contact with Centrelink to ensure students receive the highest (Masters) level of Abstudy
• Encouraging students to apply for a $3,000 Summer scholarship in research
• Discouraging students from taking an external job while studying medicine.

Aunty Kerrie and Paul work from offices located about 15 metres from the Indigenous support unit their students use and less than 50 metres from the School of Medicine. They are highly accessible and encourage students to knock on their doors at any time.

“I announce at the beginning of every year: ‘We’re not happy if you’re hungry and we’re not happy if you’re homeless, so call me. We can sort anything’,” Aunty Kerrie says. “I think having that safety net there is a big help for a lot of our students. Some of them have come to the course without even a laptop.”

Both Aunty Kerrie and Annemarie are skilled at reeling in funds from multiple sources to cover the cost of additional resources – be it a computer a place to stay or tutoring. This ‘can-do’ attitude on the part of the leadership team makes a difference in a university environment where funding is tight.
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“We really don’t lose any [students] now. We have had a couple fail due to an accident or illness but they’re not failing because they can’t do the work or because they’re not interested; they’re failing because of life events.”

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.Attrition rates have dropped substantially since the support program was implemented: “We really don’t lose any [students] now. We have had a couple fail due to an accident or illness but they’re not failing because they can’t do the work or because they’re not interested; they’re failing because of life events,” Aunty Kerrie says.

 
Career Pathways

The variety of Indigenous medical specialists who have graduated from the WSU medical program is a point of pride for this relatively young medical school. These specialists include a Neurologist, an ED specialist, two Dermatologists and, very soon, the first Indigenous female Surgeon.

The WSU Indigenous Health team meet with the NSW Health and Education Institute (HETI) at least three times a year to support transition of Indigenous students from medical school. They discuss vocational training preferences with the students and provide information on what the different medical colleges are looking for and how to approach the interviews. They also encourage students to have least at least one publication as first author (e.g. in Journal of Public Health) by the time they graduate.

Paul believes that the most critical factor holding back the growth of Indigenous specialists is a lack of Indigenous leadership: “As with anything, you need to build Indigenous agency in whatever it is that you’re doing. If it’s the School of Medicine, you need to recruit Indigenous people – and not just level A, they need to be Indigenous leaders. We’ve got that with Aunty Kerrie. Annemarie recognised the need for that and we are now witnessing the impacts.”
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“We want to graduate doctors with the generic attribute of being able to offer unconditional positive regard for Indigenous people.”
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For Aunty Kerrie, the green shoots seeded by the program create the greatest joy: “I got a letter from this Aboriginal woman I know to thank me for teaching the students how to care for Aboriginal people. She was admitted to the Emergency Department at Wyong and said she’s never had a doctor before who really knew the questions to ask her. That was really heartening for us. We want to graduate doctors with the generic attribute of being able to offer unconditional positive regard for Indigenous people.”