onemda vichealth koori health unit dr dick sloman rethinking teaching students about working with...
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OnemdaVicHealth Koori Health Unit
Dr Dick Sloman
Rethinking teaching studentsabout working with clients from diverse backgrounds
OnemdaVicHealth Koori Health Unit
Consultation Frameworks• Pendelton model: doctor centred• McWhinney model: patient centred• Mead & Bower: ‘doctor as a person’• US evidence of racial disparities in health providers’ behaviours
OnemdaVicHealth Koori Health Unit
Beyond ‘Essentialism’• Students’ & doctors’ preference for recipes• External soluble problems vs internal reflection• No ‘essence’ of Indigenous Australia• Alternative:
‘provide students with opportunities to look at their biases, challenge their assumptions, know people beyond labels, confront the effects of power & privilege, and develop a far greater capacity for compassion & respect’
OnemdaVicHealth Koori Health Unit
Personal Approach• Inner Melbourne multi-cultural, low income community GP experience:
- no recipes - tried to find connections from clues about history, language, country of origin, and other sources- seemed to be welcomed,
• Instead of stereotyped assumptions, engaged with how patients saw themselves
OnemdaVicHealth Koori Health Unit
Inequalities Discourses & Australia• Carlisle: public discourses about inequalities
- Redistributionist Discourse (RED)- Social Integrationist Discourse (SID)- Moral Underclass Discourse (MUD)
• NT Emergency Intervention & opinion poll research shows people divided in themselves about Indigenous issues
OnemdaVicHealth Koori Health Unit
Cognitive Errors in Medicine • Jerome Groopman ‘How Doctors Think’• Pat Croskerry, Emergency Medicine Academic: - majority of doctors’ errors are ‘thinking’ errors, rather than poor knowledge - all people use unconscious shortcuts, including experienced doctors - can lead to cognitive & affective errors - strategies used to prevent these include: metacognition, simulation, cognitive forcing
OnemdaVicHealth Koori Health Unit
OnemdaVicHealth Koori Health Unit
Strategies from Social Psychology • Recent publication proposing strategies to reduce racial bias of health care providers• Based on social psychology research about ‘implicit’ or unconscious biases• These biases affect non-verbal behaviour & not readily changed• Despite this, strategy proposed to improve interactions through ‘individuation’
OnemdaVicHealth Koori Health Unit
Specific Strategies to Enhance:1. Internal motivation & avoid external pressure
to reduce bias 2.Understanding of psychological basis of bias3.Confidence to interact with socially dissimilar
patients4.Emotional regulation skills specific to
promoting positive emotions5.Perspective taking & affective empathy6.Ability to build partnerships with patients