RACS is one of the first medical colleges to identify the need to introduce a dedicated Cultural Competence and Cultural Safety Competency.

This new competency was developed in collaboration with the Indigenous Health Committee and Indigenous surgeons in Australia and Aotearoa New Zealand.

It was introduced to support improvement of Indigenous health outcomes and guide members on how to provide culturally safe care.

The new competency was introduced in June 2020 and is available at: https://bit.ly/3CMpuHs

Having a dedicated Cultural Competence and Cultural Safety Competency framework highlights to RACS members the importance of improving Indigenous health outcomes by providing appropriate culturally safe care to Aboriginal, Torres Strait Islander people and Māori. It also highlights the need to provide culturally safe care to all Indigenous patients, families, communities and colleagues.

Developing the Professional Skills Framework
The implementation of the new Cultural Competence and Cultural Safety Competency is supported by the Professional Skills Framework. This framework was developed in collaboration with the Indigenous Health Committee and Indigenous experts in Australia and Aotearoa New Zealand and will provide a framework for everyone in the College implementing the new competency. The framework identifies learning outcomes across the three stages of surgical training, including statements identifying what a Trainee should know and be able to do in early, mid and late SET.

The final draft of the framework was presented to the Board of Surgical Education Training (BSET) on 15 October 2021, and will be presented to the Specialty Training Boards for review. The next stage of the framework development will include an appropriate Assessment Framework to support specialty boards and trainers implementing the newly identified Learning Objectives.

Training our Fellows to implement the new competency
To support the implementation of the new competency, RACS has been developing and delivering a range of professional development courses for our members. The Indigenous Health team has also been developing and providing a range of training across all sectors of RACS, including targeted professional development for training boards, Cultural Safety and Indigenous health sessions—through Indigenous providers and the new Aboriginal and Torres Strait Islander courses—and the Maori Indigenous Health Institute (MIHI) training with the University of Otago in Aotearoa New Zealand.

The most appropriate training was identified by BSET and the Specialty Training Boards to support the implementation of the new competency and the Professional Skills Framework. This training commenced with BSET on  14 October and the Board of Vascular Surgery on 22 October. Training will be delivered to other Boards in early 2022.

AIDA Aboriginal and Torres Strait Islander health in clinical practice
The first AIDA Aboriginal and Torres Strait Islander Health in Clinical Practice (ATSIHICP) session was held in Brisbane on 17 July with a broad range of RACS Queensland Fellows attending. The session was delivered by Associate Professor Shannon Springer and Dr Ngaree Blow (pictured above left) at the RACS Queensland office. The session provided RACS Fellows an opportunity to learn more about connection to country and how holistic health perspectives are different to Western biomedical approaches. They also learned about how racism is impacting Indigenous Health outcomes and considered what they can do differently in their practice to address these disparities.

The RACS Fellows participated in a yarning circle with the facilitators to talk about what they are going to implement in their practice. Lindy Jeffree, a neurosurgeon from Queensland said, “It was a fascinating and enjoyable interactive session that synthesised the challenges faced by Aboriginal and Torres Strait peoples within our health system. We learnt the strategies that non-Indigenous doctors can use to improve the clinical experience. The stories and examples of how to provide culturally safe clinical encounters left me inspired to improve recognition, access, and outcomes for my Aboriginal and Torres Strait Islander patients and colleagues.”

Associate Professor Bernard C.S. Whitfield said, “The AIDA session in Brisbane significantly enhanced my understanding of ‘sorry business’ and its implications.”

Professor Yin Paradies' Indigenous Health and Cultural Safety sessions in Australia RACS has also developed and delivered a customised online Indigenous Health and Cultural Safety session delivered by Professor Yin Paradies. These were delivered to the Melbourne Fellows on 9 October and to the Sydney Fellows on 6 November.

Professor Paradies is an Aboriginal-Asian-Anglo Australian of the Wakaya people from the Gulf of Carpentaria. He is also the Chair in Race Relations at Deakin University and is developing this training. Professor Paradies said, “Providing optimal healthcare requires an understanding of colonisation, the nature of health disparities, aspects of Indigenous culture, and effective approaches to addressing the detrimental impacts of racism and privilege in medical contexts. Surgeons have found this in-depth exploration of cultural safety engaging and influential in relation to their ongoing practice.”

Training for trainers in Aotearoa New Zealand
RACS has collaborated with the Hui Process/Meihana Model to deliver the MIHI course customised for surgeons.
The course entails a range of components, including online learning, onsite learning, and assessment modules. The topics will explore the context of Hauora Māori and include Te Roe within a clinical setting and understanding the context for studying Māori health. Orientation to the Hui Process and Meihana Model and its application can help reduce clinical bias and improve health literacy along with the role of Whakateres.

The objective of the course is to support health practitioners to feel informed and confident in the development of Hauora Māori competencies, specifically focusing on the Hui Process and Meihana Model.   The different components of the training are:

- onsite training seminar in Christchurch,
- including team-based learning activities to orientate  learners to the Hui Process and Meihana Model
- simulated patient sessions to practice
- application of Hui Process and Meihana
Model to clinical practice
- face-to-face courses assisting learners
to apply these models within their clinical practice alongside Māori patients and/or whānau. These models promote positive engagement, appropriate care and treatment, and health advocacy that support Māori health equity.

Learners will receive feedback about their progress through assessment modules, which require them to demonstrate their ability to use the Hui Process and Meihana Model in clinical practice. They also complete a case assignment involving a virtual patient case that allows them to demonstrate how they apply the Hui Process/Meihana Model.
If the learner chooses to continue their learning past Assessment 1, they can complete another written assignment. This involves interviewing a Māori patient with whom they are working and completing the assignment.

eLearning training (Aboriginal and Torres Strait Islanders)
To support delivery of the new competency Fellows, SIMGs, Trainees, and JDocs can undertake the Aboriginal and Torres Strait Islander eLearning courses. These courses have been specifically developed with the requirements of surgeons in mind. They were designed and developed in collaboration with a range of Aboriginal and Torres Strait Islander partners to ensure they provide an authentic Indigenous perspective.

More information on the courses and access to them is available through the RACS Indigenous Health webpage - https://bit.ly/3HPmvSC

These courses are designed to be completed over an extended period and are broken down into  self-contained 30-minute self-contained modules. Members will be issued a certificate on completion of the full course along with 10 hours of CPD for the new Cultural Competence and Cultural Safety Competency. The courses can be used each year towards the CPD requirements for the Learning Plan related to the new competency.

To support delivery of the eLearning courses the RACS library has purchased access to a range of online and hard copy books highlighted in the courses for members to use. The RACS library page provides access to the Informit – Indigenous Database along with a range of suggested articles, books and other relevant resources for Australia and Aotearoa New Zealand. If you would like access to other books or resources, please contact the RACS Library.
Next steps

The focus for 2022 will be on finalising the Assessment Framework and implementing the Professional Skills Curriculum into the specialty Board curriculum documents. The Indigenous Health team will provide support for training our members, inclusion of questions in the surgical education training entry process, and the curriculum documents. The RACS Indigenous Health team will work closely with BSET and the Boards to ensure they have the support to implement the competency in a culturally safe way.

If you need assistance please contact the RACS Indigenous Health team: [email protected]

This program is funded by the Australian Government Department of Health through the Specialist Training Program (STP).