Challenges of Indigenous placements

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Challenges of clinical education placements working with Aboriginal and Torres Strait Islander people

Clinical educators need to consider a number of factors before offering a placement in an Indigenous health context. Working with Aboriginal and Torres Strait Islander people requires diverse skills and knowledge and often a quite different ‘mindset’ from any the student might have needed in other clinical contexts.

• Relationships are often central to effective practice: the clinical educator might be concerned that having a student with them (e.g. when on a community outreach visit) might jeopardise a situation where they have spent a long time developing relationships and trust.
• Aboriginal and Torres Strait Islander health issues are often complex and multi-layered:  the clinical educator might be concerned that the student does not have the breadth of theoretical knowledge to benefit from the placement or will not see enough straightforward ‘bread and butter’ clients.
• Appropriately ‘client-centred’ assessment and intervention techniques might need to be adapted, dynamic or informal: this requires confidence and a thorough understanding of the basis of the clinical process and the clinical educator might not feel confident facilitating these ‘higher level’ skills.
• A student faced with the disparity between Indigenous and non-Indigenous health outcomes might find the experience confronting:  the clinical educator may need to be willing to help students understand the historical, social, economic, political and cultural determinants involved in each particular case.
• Clinical educators can find the prospect of ensuring students develop cultural awareness and appropriate communication skills daunting.
• Clinical educators can be concerned that the importance of the right attitude, values and personal qualities are often emphasised within an Aboriginal and Torres Strait Islander context:  the clinical situation needs flexibility, patience, a degree of informality and an essential respect for Indigenous people. “If you’ve got a person with the right attitude, who’s non-judgemental, who’s open, willing to accept difference, then they will learn those cultural things as they go along.” (Nelson, Allison & Copley, 2007, p.211). The clinical educator might be concerned about what to do if the student does not seem ‘to fit’.  They might be concerned about how to modify these personal attributes if change is needed.
• Attendance is often inconsistent within Aboriginal and Torres Strait Islander contexts: clinical educators might be uncomfortable about guaranteeing students on placement that they will accrue enough of the ‘clinical practice hours’ required for accreditation.
• All of the factors relating to working within a rural or remote setting may also be relevant.
  

Tackling the challenges of clinical education placements working with Aboriginal and Torres Strait Islander people

It has been suggested that Indigenous placements should always be based on the principle that they are ‘a privilege and not a right’ (Whitford, Taylor & Thomas, 2013, p.340). The clinical educator needs to consider the relevance and possible impact of these challenging factors carefully. Some of these challenges might simply need to be accepted as inevitable, but worth tackling, to achieve the benefits of providing clinical education placements in Indigenous contexts. However, many of the challenges can be eased by:

• preparing students adequately for placements; and
• adapting the structure or nature of the placement.

Another key strategy is to allow more time than might be usual in other placements contexts to tackle many of these challenges. Time is important:

• for the student - to spend more time talking, observing, reading and reflecting about what they are experiencing and learning; and
• for the clinical educator - to spend more time with the student explaining, facilitating, discussing and working through some of the information, skills and attributes that will allow the student to benefit from the placement.

Clinical Education placements for Aboriginal and Torres Strait Islander Students

The Congress of Aboriginal and Torres Strait Islanders Nurses and Midwives - Good Clinical Placements Guide is a guide for universities and health services to create culturally safe clinical placements for Aboriginal and Torres Strait Islander Nursing and Midwifery students, and includes content that can be transferable to other health professions.