Challenges of Indigenous placements

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.
 
The information in this section was identified in interviews with clinicians working with Aboriginal and Torres Strait Islander people.
 

Challenges of Offering a Clinical Education Placement Working with Aboriginal and Torres Strait Islander people

What are your concerns about offering a clinical education placement?

Do you have any control over these issues?

 


References and Additional Reading
Nelson, A., Allison, H. and Copley, J. (2007). Understanding where we come from: Occupational therapy with urban indigenous Australians. Australian Occupational Therapy Journal, 54 (3), 203-214.

For some background reading that explores the basis of these challenges see:
Davidson, B., Hill, A., and Nelson, A. (2013). Responding to the World Report on Disability in Australia: Lessons from collaboration in an urban Aboriginal and Torres Strait Islander school. International Journal of Speech-Language Pathology, 15 (1), 69-74.
Nelson, A and Allison, H. (2007). Relationships: the key to effective occupational therapy practice with urban Australian Indigenous children. Occupational Therapy International, 14(1), 57 – 70.
Nelson, A., Gray, M., Jensen, H., Thomas, Y., McIntosh, K., Oke, L., and Paluch, T. (2011). Closing the gap: supporting occupational therapists to partner effectively with First Australians. Australian Occupational Therapy Journal, 58 (1). 17-24.
Nelson, A., Shannon, C., and Carson, A. (2013). Developing health student placements in partnerships with urban Aboriginal and Torres Strait Islander Community Controlled Health Services. Lime Good Practice Case Studies, Volume 2, 29-34.


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