General Practitioner Supervisor assessment and teaching of Registrars consulting with Aboriginal patients – is cultural competence adequately considered?

Abstract

BackgroundGeneral Practitioner (GP) Supervisors have a key yet poorly defined role in promoting the cultural competence of GP Registrars who provide healthcare to Aboriginal and Torres Strait Islander people during their training placements. Given the markedly poorer health of Indigenous Australians, it is important that GP training and supervision of Registrars includes assessment and teaching which address the well documented barriers to accessing health care.MethodsA simulated consultation between a GP Registrar and an Aboriginal patient, which illustrated inadequacies in communication and cultural awareness, was viewed by GP Supervisors and Medical Educators during two workshops in 2012. Participants documented teaching points arising from the consultation which they would prioritise in supervision provided to the Registrar. Content analysis was performed to determine the type and detail of the planned feedback. Field notes from workshop discussions and participant evaluations were used to gain insight into participant confidence in cross cultural supervision.ResultsSixty four of 75 GPs who attended the workshops participated in the research. Although all documented plans for detailed teaching on the Registrar’s generic communication and consultation skills, only 72% referred to culture or to the patient’s Aboriginality. Few GPs (8%) documented a plan to advise on national health initiatives supporting access for Aboriginal and Torres Strait Islander people. A lack of Supervisor confidence in providing guidance on cross cultural consulting with Aboriginal patients was identified.ConclusionsThe role of GP Supervisors in promoting the cultural competence of GP Registrars consulting with Aboriginal and Torres Strait Islander patients could be strengthened. A sole focus on generic communication and consultation skills may lead to inadequate consideration of the health disparities faced by Indigenous peoples and of the need to ensure Registrars utilise health supports designed to decrease the disadvantage faced by vulnerable populations.

Developing cultural competence in general practitioners: an integrative review of the literature

“…This suggests there is general willingness for GP registrars to undertake further training, but they require more resources and support and facilitation of this training by clinical role models, medical educators and culturally diverse staff and community members. The central role of the GP supervisor in GP registrar training (through role modelling, mentoring and clinical supervision) suggests that GP supervisors do have a role in developing the cultural competence of their GP registrars, but that role needs to be further elucidated and developed [15–17]. …”

“…How cultural competence is developed in GP registrars in this setting is unclear, with much of focus in the literature being on medical student and hospital staff training. The GP supervisor has been described as the most important person involved in the training of Australian General Practitioners, however their role in developing and assessing the cultural competence of GP registrars is unclear [15–17]. A greater understanding of the current cultural competence training literature in the specific context of General Practice will enable better insight into its complexities, further development of effective training models and inform review of current training standards.…”

Exploring the incidence of culturally responsive communication in Australian healthcare: the first rapid review on this concept

“…The results of this review indicate that healthcare practitioners lacked confidence in their ability, skills or knowledge to achieve effective culturally responsive [36,38,40,45,48]. This resulted in many healthcare practitioners adopting a generic 'onesize-fits-all' style of communication, thereby displaying attitudes of 'cultural blindness' [12,28,34,40,50].…”

“…The literature suggests that these factors were often absent from many healthcare workplaces. Availability of resources and literature in relevant languages with appropriate graphics is also a factor indicating a commitment to culturally responsive communication [32,34,37,38,40,41,43,45,46,49,50]. The employment of culturally diverse staff reflecting the represented cultures of its service users [26, 28-30, 37, 40, 45, 46], along with the availability and use of quality interpreter services contribute to the ability to achieve culturally responsive communication [12,26,28,29,32,34,41,45,46,49,50].…”

Multiculturalism in Healthcare: A Review of Current Research into Diversity Found in the Healthcare Professional Population and the Patient Population

“…7,45 Such factors affect social inclusion which has been found to promote wellbeing, mental health, and decision making capacity and discourages discrimination and stigma, 46 and also increases the anxiety of the situation, for fear of being stigmatised or outcast from society for attempting to access healthcare, resulting in less willingness to access the care they need. 26,38,39,47,48 One of the other barriers to healthcare is how healthcare professionals are facing multiculturalism in healthcare which has resulted in "culturally competent care [that was] misguided or insufficient". 44 There have also been notable shortcomings in policy and regulation in trying to achieve cultural competence, 42 on top of issues such as stereotyping, 25 time pressures in accessing the information that the healthcare professionals require 45 and lack of training.…”