Thread by @DrJoannaT

Time for the first keynote. @rg_jones from Te Kupenga Hauora Māori, University of Auckland.

He will be talking about "Moving backwards into the future: Indigenising the health professional curriculum"

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@rg_jones He starts by asking us to think about designing health professional education - if we build things off what we have done previously, we might miss some of the biggest concerns of the present time - climate change and impact of biodiversity

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Rhys introduces the Maori perspective on knowing/time: we only already know what we've already experienced/what we have faced - i.e. the past ... the future is 'behind' us (i.e. we can't see it) ... so, his talk title builds on this.

So, today he'll be talking from his experience in building Indigenous health curriculum and as a doctor. He recalls his own start at med school where there were few Maori and Pacific colleagues/students - a far cry from now. Now he's back at his alma mater.

He counts himself lucky that there was already a lot set up at his university in terms of health services and teaching faculty and systems to support an Indigenous health curriculum.

So... they developed a formal curriculum and this document (now 10+ years old) which set out goals: fmhs.auckland.ac.nz/assets/fmhs/fa…

And drew on critical work: otago.ac.nz/press/books/ot…

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So not just about knowing the social inequities that impact Maori health - also knowing why those social inequities came about, and the complex circumstances of the world - like structural racism. And moving away from cultural essentialism.

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Rhys advocates for cultural safety, and critical consciousness in this paper with colleagues: equityhealthj.biomedcentral.com/track/pdf/10.1…

Much more than remembering a list of '5 things' - to understanding self within society and what we can all do in everyday practice

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Rhys also suggests that we need to ensure that Indigenous health curricula needs to address those critical determinants of Indigenous health - admits it sounds silly to point out something so obvious, but it is incredibly important

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Ah, now we move on to assessment - previously there wasn't much, and you could progress to the next year while failing the Maori health assessment - termed 'all gums and no teeth' - so very much not ideal. Now mapped across the curriculum.

And, mandatory to pass the Maori curriculum components (just like everything else, I expect) so students could fail if they don't learn these bits right. Sends a strong message to students.

Rhys points out that while the formal curriculum is only a small slice, learning happens about Indigenous health across the curriculum - and some of that is possibly 'unlearning' (a snakes and ladders scenario). So need to ensure it is all anti-racist and critical.

The hidden curriculum is quite powerful, and also much of Western medicine is built on unethical and abhorrent beginnings which contributed to the colonisation of many lands. So need to take those steps towards dismantling colonialism as basis of practices and institutions.

Rhys is now going to share an example of this - since decolonisation can seem daunting and abstract at times - drawing on work by @SuzannePitama and colleagues in clinical history taking, which focusses on building connections with Maori pts & families.

So, instead of using it 'alongside' Western formula as an isolated activity, they integrated it as part of the standard curriculum.

(I think this is it: assets-global.website-files.com/5e332a62c703f6… )

Rhys also mentions the collaborative international consensus statement on Educating for Indigenous Health Equity:

journals.lww.com/academicmedici…

So, what else can we do now. "Pedagogies of discomfort" important and valuable in this context - Rhys cites Felman jstor.org/stable/26304031

And suggests students and teachers must be invited to embrace vulnerability to experience transformation.

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So then we need to reconcile how discomfort can be created while still maintaining classroom safety. Especially since decolonial action means challenging fundamental identity.

But one is not the absence of the other - cites Zembylas tandfonline.com/doi/abs/10.108…

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If we only uphold safety, then we are also upholding power and privilege for those who are already in those powerful and privileged groups. It ends up not being safe at all for Indigenous people and people of colour.

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So even though this might be perceived as violence, it is humanising violence?

tandfonline.com/doi/abs/10.108…

And the notion that we need to attend to the discomfort and 'comfort' those needs to be dismantled - if we pander to those feelings then we're contributing to white fragility

cambridge.org/core/journals/…

Instead, we need to have mana-enhancing teaching & learning - not about apportioning individual guilt/blame, instead try this deconstructing approach (from Australian colleagues at Flinders)

ijcis.qut.edu.au/article/view/1…

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So, now to consider how to ensure we can all enact anti-racist pedagogies in our teaching & learning.

Paradoxically the focus in learning has been on non-Indigenous students... but Indigenous students experience significant racism and overall it's not great.

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Suggests things like differentiated curriculum (since what needs to be learned is very different), separated spaces?

But also need to teach the teachers to be decolonised (yes please!)

At Auckland they've developed resources for clinicians within clinical settings but feels like only scratching the surface, lots more to do.

Key messages from @rg_jones - what an amazing way to start off #ANZAHPEFestival, and especially in this #NAIDOCWeek2021 ! 🙏🏽🙏🏿🙏🏻🙏🏽🙏🏾🙏

I've lost the thread a little with the questions since screenshots apparently take a lot of cognitive load. But I think the 1st one was about involving students in discussion and sharing varied experiences. 2nd about learning health practices - situated learning important.

So, go to the places of Indigenous health learning (where appropriate and possible) and learn in that way - to understand how different and discomforting attending a Western health clinic might be.

Now a q on assessment - is the way we assess from a deficit perspective rather colonial, and would this look different from a decolonial perspective? A: we need to be much more creative than we have been so far - beyond current written/clinical assessment - to longitudinal

Processes that take a lifetime, becoming/being that never stops. So how do we tap into that in assessment. But also need to engage Indigenous communities to understand ways of learning and looking at progress.

Q about international students who are coming to study in A & NZ health professions courses. A is that actually we should value this diversity as they are likely to have also have experiences which we can learn from.