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Table 2 Identified learning and teaching needs to be discussed in feedback session

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

Category

Frequency

Interview data (RTP A & B)

General teaching points

Communication and consultation skills

100% identified this as an area requiring improvement, and all gave at least one specific detail to be addressed in feedback session

‘Less didactic, paternalistic approach’ (A3)

‘Respectfulness – meet the patient on the same level as a participant on the same journey’ (A4)

‘Locus of control remained with doctor – no likelihood of improved management or self care’ (A6)

‘Criticising patient too much’ (B25)

‘Listen- patient agenda not GP agenda’ (A15)

‘Not patient- centred’ (A16)

‘Bad basic consultation skills for any patient’ (A10)

‘Doctor needs to check patient understanding before going on to other issues’ (B36)

‘No open ended questions to allow her to discuss her concerns’ (B41)

Cultural awareness and understanding

72% (48/64) identified a need for the registrar to better consider the patient’s culture or Aboriginality within the consultation

‘Understanding of Aboriginal culture & awareness’ (A4)

‘Lacks exploration of patient’s many social and cultural factors and needs’ (B37)

‘Cultural respect and safety’ (B45)

‘Once you identified the patient as Aboriginal what other cultural issues did you need to address?’ (A9)

66% (42/64) gave at least one specific detail related to the Aboriginal context or Aboriginal health to be addressed in registrar feedback (see below)

Specific teaching points relevant to culture or Aboriginal health

Cultural issues impacting on the consultation

42% (27/64) - Cross cultural communication/consultation

‘Explore ways in which he may alter his management style to be more culturally appropriate’ (A3)

28% (18/64) - Identification of and terminology around Aboriginality

‘Made judgement about Aunt’s Aboriginality without asking. “Part Aboriginal” doesn’t exist’ (A5)

‘Understanding of the meaning of Aboriginality’ (A10)

27% (17/64) - The significance of Elders and family, and how to manage in a consultation

‘Didn’t acknowledge or thank the Aunty’s presence, support and contribution’ (B29)

17% (11/64) - Ensure lifestyle advice is culturally appropriate

‘Do you think an Aboriginal lady, short of money…plays tennis?’ (A1)

‘Assumption of appropriateness and usefulness of handouts’ (B9)

14% (9/64)- Sorry business (bereavement)

‘Acknowledgment of the ‘Sorry’ event that had affected her life’ (B33)

‘Acknowledge demands of Sorry business’ (A6)

Health

9% (6/64) - Health issues of particular importance in Aboriginal people

‘Awareness Aboriginal higher risk of having cardiac disease’ (B14)

Supports to assist patient to manage heath needs

14% (9/64) - Access Aboriginal healthcare providers and services

‘Try to involve Aboriginal health worker and support.’ (B15)

‘Referral to Aboriginal services/dietitian who have better understanding of Aboriginal culture.’ (B17)

‘Referred to allied health - didn’t check re transport issues’ (A5)

8% (5/64)- Identified the relevance of government funded initiatives to support health care costs and support needs (Closing the Gap program)

‘Failure to appreciate money – costs of meds. CTG could be used.’ (B41)

Supporting ongoing learning in Aboriginal health

Response to question ‘What educational resources may be helpful?’

20% (13/64) - cultural awareness learning resources (including specific reference to workshops, written and visual materials)

‘Aboriginal awareness training’ (A4)

A day at Aboriginal health centre. Reading material. Video.’ (A3)

16% (10/64) - accessing cultural advice and mentorship from Aboriginal people

‘Discussion with Aboriginal Health Worker. Sitting in on consultation with mentor.’ (A5)

8% (5/64) - recommended Registrar needed improved knowledge of Aboriginal history

‘History of Aboriginal self-determination. Many GPs weren’t born or educated in Australia – are unaware of the stolen generation, referendum Aboriginal vote’ (B16)